2026 SOAP Annual Meeting

The effect of painful contractions on time perception during epidural placement for labor analgesiaKatie Hatter, MD, Jessi Stockinger, MD, Haley Nitchie, MHA, Courtney Condon, BS, & Latha Hebbar, MD

Background

Time PERCEPTION ≠ Physical Time

Emotion, attention, & anxiety influence subjective passage of time.

Acute pain can cause expansion of time perception.

Hypothesis

Patient-reported pain score during epidural placement is associated with patient-reported time to placement.

Methods

•Women ≥ 18 years old presenting for a vaginal delivery at MUSC’s Labor & Delivery Unit

•Exclusion Criteria

•History of opioid medication use or substance use disorder

•History of pre-existing chronic pain conditions

•Use or pre-medication for pain control (nalbuphine, nitrous oxide, etc.)

•Painful contractions while consenting for labor epidural*

•Non-English-speaking patients

•Information Collected

•Age, BMI, self-reported race & ethnicity

•Number of prior births and mode of delivery

•History of prior epidural and mode of delivery

•Urgency of cesarean delivery – elective or unplanned

•Induction vs spontaneous labor

•Pain score (VAS scale) with or without contractions during epidural placement

Results

Pain score during epidural placement with or without contraction was not associated with perceived time to epidural placement.

Only observed time to epiduralplacement and having a prior epidural was associated with perceived time.

•A 5-minute increase in observed placement time was associated with a 3.1-minute increase in perceived time to placement, (P < 0.001)

•Having a prior epidural was associated with a 2-minute increase in perceived time to placement, adjusting for other factors (P = 0.0140)

111/295 (37.6%) estimated placement time was larger than the observed placement timeI

Discussion/Conclusion

In the setting of acute cyclical pain of labor and pain associated with labor epidural placement, retrospective temporal sensitivityand subjectiveperceptionof therate of passageof time is not altered.

Limitations

•Did not account for confounding variables – BMI, ADHD, anxiety, depression •Exclusion of patients in severe pain •Prospective study design with retrospective question

Clinical Implications •Patient education by anesthesia team •Encouraging earlier request of labor epidural

Future Directions •Comparing patient satisfaction with time perception •Comparing time perception or patient satisfaction with or without variables: music, provider narration

2026 SOAP Annual Meeting

The Effect of Painful Contractions on Time Perception during Epidural Placement for Labor Analgesia

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