The association between pain intensity during epidural labour analgesia and intrapartum hyperthermia: a multicentre prospective observational study

Jin, KX; Wang, S; Song, XR; Zhang, JL; Yan, J; Li, B; Shi, ZW; Luo, Q; Wang, XD; Jiang, F; Ding, X; Zeng, Y; Bai, YW; Zhang, J; Jia, JX; Tu, YY; Lei, B; Bao, AR; Deng, CM; Ding, T; Sessler, DI; Wang, DX

doi:10.1016/j.bja.2026.08.059

Obstetric anaesthesia

The association between pain intensity during epidural labour analgesia and intrapartum hyperthermia: a multicentre prospective observational study

Br J AnaesthPublished 16 Oct 2026multicentre prospective observational study

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Authors' conclusion

Among nulliparous women receiving epidural analgesia for labour, lower pain scores were associated with higher odds of hyperthermia. Extensive sympathetic blockade may promote maternal hyperthermia.

Study context

Population: Nulliparous women with term cephalic singleton pregnancies who planned vaginal delivery with epidural analgesia
Participants: 952 participants

Exposure: Pain intensity (11-point numerical rating scale, as time-weighted average, average, area under the curve and peak scores) during epidural labour analgesia and intrapartum hyperthermia
Outcome: Intrapartum hyperthermia (≥38°C)

Main finding

As reported in the abstract

Lower pain intensity associated with higher odds; adjusted for confounding factors

OR for intrapartum hyperthermia (95% CI)P value

Time-weighted average pain score (lower pain intensity)

1.64(1.40–1.91)

P < 0.001

Average pain score (lower pain intensity)

1.56(1.35–1.81)

P < 0.001

Area under the curve of pain scores (lower pain intensity)

1.05(1.03–1.07)

P < 0.001

Peak pain score (lower pain intensity)

1.19(1.09–1.30)

P < 0.001

Intrapartum hyperthermia occurred in 13% (124/952) of participants: 13% (124/952)

Observational data: associations, not effects.

Further findings

Intrapartum hyperthermia at identified inflection points of pain scores

	← Lower ←→ Higher →	OR for intrapartum hyperthermia (95% CI)	P value
Time-weighted average score ≤3 pointsAssociated with increased intrapartum hyperthermia	0.050.21520	8.67 (4.19–17.9)	P < 0.001
Average score ≤3 pointsAssociated with increased intrapartum hyperthermia	0.050.21520	6.63 (3.56–12.3)	P < 0.001
Area under the curve ≤30 point⋅hAssociated with increased intrapartum hyperthermia	0.050.21520	13.0 (3.75–45.0)	P < 0.001
Peak score ≤4 pointsAssociated with increased intrapartum hyperthermia	0.050.21520	2.53 (1.65–3.89)	P < 0.001
	0.050.21520OR for intrapartum hyperthermia (log scale)

Participant age

Median age: 29 yr

Original publication

The association between pain intensity during epidural labour analgesia and intrapartum hyperthermia: a multicentre prospective observational study. Br J Anaesth. Published 16 October 2026. doi:10.1016/j.bja.2026.08.059

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