Comparing Sedara to Butorphanol in Early Labor

NCT ID: NCT01636999

Last Updated: 2020-10-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

NA

Study Classification

INTERVENTIONAL

Study Start Date

2012-09-30

Study Completion Date

2014-09-30

Brief Summary

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Nitrous oxide (N2O) has been used for the treatment of labor pains for over 150 years. The longevity of its use in clinical practice can be attributed to its excellent safety profile, ease of administration, and familiarity of use among health-care providers. Sedara is a self-administered 50% N2O, 50% oxygen gas mixture with pain relieving and anxiety reducing properties recently available for use in the United States (US) to treat various painful clnical situations, including labor pains.

In the US, epidural or intravenous administration of narcotic medications is one of the most common and frequently requested treatments for patients experiencing labor pains. Although generally considered safe, complications are common with epidurals, including fetal distress, low blood pressure in the mother, respiratory distress, and headache. In our hospital system, the use of the synthetic intravenous painkiller, Butorphanol, is a mainstay of treatment for labor pains. It too can have undesirable side effects in the mother, including low blood pressure and breathing problems.

Because Sedara has until recently been unavailable in the US, studies comparing its efficacy with other agents for labor pain have been confined to Europe, predominantly in the United Kingdom. Several studies have investigated the efficacy of Sedara versus inhalation and intravenous anesthetics in various countries. We have obtained several Sedara devices for use in the West Penn Allegheny Health System (WPAHS) Department of Anesthesiology and would like to examine its efficacy in our target population of women experiencing pain during early labor.

Hypothesis - Sedara will provide equivalent or superior pain relief among term, adult parturients in early labor (less than 5cm cervical dilation) compared to intravenous butorphanol.

Primary aim - Compare Sedara versus butorphanol in a single-blinded randomized trial with the main outcome measure being reduction in labor pains at various time intervals.

Our findings may be significant in terms of improving safety and efficacy of pain relief among women experienceing labor pains. Given that Sedara has not been previously studied in the US, the results may influence current obstetrical and pain management practices.

Detailed Description

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Conditions

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Labor Pain

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Butorphanol

The main study arm will be examining how well a 50% Nitrous Oxide/50% Oxygen gas mixture is in reducing labor pains in term labor patients with less than 5 cm cervical dilation, compared to 2mg of Butorphanol (a common synthetic opiod used for labor pains in this setting).

Group Type EXPERIMENTAL

50% Nitrous Oxide/50% Oxygen

Intervention Type DRUG

The gas mixture is provided via the Sedara portable gas delivery system. This system is equipped with a non-rebreather mask which the patient holds over their mouth and nose. The delivery of the gas is only triggered by the patient's spontaneous breath. The gas machine will be provided to the patient to use as much as they like during the 60 minutes data collection period. The only dose which the machine allows to be administered is 50% Nitrous Oxide/50% oxygen.

Interventions

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50% Nitrous Oxide/50% Oxygen

The gas mixture is provided via the Sedara portable gas delivery system. This system is equipped with a non-rebreather mask which the patient holds over their mouth and nose. The delivery of the gas is only triggered by the patient's spontaneous breath. The gas machine will be provided to the patient to use as much as they like during the 60 minutes data collection period. The only dose which the machine allows to be administered is 50% Nitrous Oxide/50% oxygen.

Intervention Type DRUG

Other Intervention Names

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Sedara (FDA 510K Approval No. K101286)

Eligibility Criteria

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Inclusion Criteria

* Female
* 18 years of age or older
* Presents in active labor
* Full term pregnancy (at least 37 and up to 42 weeks gestation)
* Less than 5 cm cervical dilation on exam

Exclusion Criteria

* Patients who have received prior regional or opioid analgesia
* Patients who have taken oral analgesics (narcotic or non-steroidal anti inflammatory drugs) within 6 hours prior to presentation
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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West Penn Allegheny Health System

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Helene Finegold, MD

Role: PRINCIPAL_INVESTIGATOR

Associate Residency Program Director

Christopher Troianos, MD

Role: STUDY_CHAIR

Residency Program Director

Locations

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West Penn Hospital

Pittsburgh, Pennsylvania, United States

Site Status

Countries

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United States

References

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Volmanen P, Palomaki O, Ahonen J. Alternatives to neuraxial analgesia for labor. Curr Opin Anaesthesiol. 2011 Jun;24(3):235-41. doi: 10.1097/ACO.0b013e328345ad18.

Reference Type BACKGROUND
PMID: 21451402 (View on PubMed)

Rosen MA. Nitrous oxide for relief of labor pain: a systematic review. Am J Obstet Gynecol. 2002 May;186(5 Suppl Nature):S110-26. doi: 10.1067/mob.2002.121259.

Reference Type BACKGROUND
PMID: 12011877 (View on PubMed)

Maslekar S, Gardiner A, Hughes M, Culbert B, Duthie GS. Randomized clinical trial of Entonox versus midazolam-fentanyl sedation for colonoscopy. Br J Surg. 2009 Apr;96(4):361-8. doi: 10.1002/bjs.6467.

Reference Type BACKGROUND
PMID: 19283736 (View on PubMed)

Young P, Emery NC, Reisin R. Epidural analgesia for labor and delivery. N Engl J Med. 2010 Jul 22;363(4):395. No abstract available.

Reference Type BACKGROUND
PMID: 20677364 (View on PubMed)

Viscomi CM. Randomized trial of epidural versus intravenous analgesia during labor. Obstet Gynecol. 1996 Mar;87(3):480-2. doi: 10.1016/0029-7844(96)82976-0. No abstract available.

Reference Type BACKGROUND
PMID: 8598984 (View on PubMed)

Dickinson JE, Paech MJ, McDonald SJ, Evans SF. Maternal satisfaction with childbirth and intrapartum analgesia in nulliparous labour. Aust N Z J Obstet Gynaecol. 2003 Dec;43(6):463-8. doi: 10.1046/j.0004-8666.2003.00152.x.

Reference Type BACKGROUND
PMID: 14712952 (View on PubMed)

Yeo ST, Holdcroft A, Yentis SM, Stewart A, Bassett P. Analgesia with sevoflurane during labour: ii. Sevoflurane compared with Entonox for labour analgesia. Br J Anaesth. 2007 Jan;98(1):110-5. doi: 10.1093/bja/ael327.

Reference Type BACKGROUND
PMID: 17158129 (View on PubMed)

Volmanen P, Akural E, Raudaskoski T, Ohtonen P, Alahuhta S. Comparison of remifentanil and nitrous oxide in labour analgesia. Acta Anaesthesiol Scand. 2005 Apr;49(4):453-8. doi: 10.1111/j.1399-6576.2005.00639.x.

Reference Type BACKGROUND
PMID: 15777291 (View on PubMed)

Talebi H, Nourozi A, Jamilian M, Baharfar N, Eghtesadi-Araghi P. Entonox for labor pain: a randomized placebo controlled trial. Pak J Biol Sci. 2009 Sep 1;12(17):1217-21. doi: 10.3923/pjbs.2009.1217.1221.

Reference Type BACKGROUND
PMID: 19943458 (View on PubMed)

Kelly AM. Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med. 1998 Nov;5(11):1086-90. doi: 10.1111/j.1553-2712.1998.tb02667.x.

Reference Type BACKGROUND
PMID: 9835471 (View on PubMed)

Yamamoto LG, Nomura JT, Sato RL, Ahern RM, Snow JL, Kuwaye TT. Minimum clinically significant VAS differences for simultaneous (paired) interval serial pain assessments. Am J Emerg Med. 2003 May;21(3):176-9. doi: 10.1016/s0735-6757(02)42255-3.

Reference Type BACKGROUND
PMID: 12811707 (View on PubMed)

Lee JS, Hobden E, Stiell IG, Wells GA. Clinically important change in the visual analog scale after adequate pain control. Acad Emerg Med. 2003 Oct;10(10):1128-30. doi: 10.1111/j.1553-2712.2003.tb00586.x.

Reference Type BACKGROUND
PMID: 14525749 (View on PubMed)

Other Identifiers

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12-007

Identifier Type: -

Identifier Source: org_study_id

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