Epidural Volume Extension During a Combined Spinal-Epidural Technique for Labor Analgesia.

NCT ID: NCT01810406

Last Updated: 2014-04-23

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 60 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2013-03-31

Brief Summary

Combined spinal-epidurals (CSE) involve the injection of pain relief medication into the cerebral spinal fluid (CSF) and the insertion of an epidural catheter in the epidural space to continue to give pain relief medication. During a CSE, after injection of the medication in the CSF and before inserting the epidural catheter, if normal saline is injected into the epidural space, there may be an increase in pain relief and an increase in the level of numbness. This injection of saline in the epidural space to increase pain relief and numbness is termed epidural volume extension (EVE). The purpose of this study is to determine if there is a benefit for EVE to improve labor analgesia (pain relief) using CSE in pregnant laboring patients.

Detailed Description

Regional analgesia (pain relief) for labor can be an epidural, a spinal or a combination of the two. Combined spinal-epidurals (CSE) are popular because of their rapid pain relief and high patient satisfaction. At the IWK Health Centre, many anesthesiologists routinely use this method of pain relief. It involves the injection of pain relief medication into the cerebral spinal fluid (CSF) and the insertion of an epidural catheter (slim plastic tube) in the epidural space to continue to give pain relief medication. The epidural space is located just outside the CSF. In order to insert the epidural catheter, some anesthesiologists inject 2-4 ml of saline in the epidural space to help the catheter go in. During a CSE, after injection of the medication in the CSF and before inserting the epidural catheter, if normal saline is injected into the epidural space, there may be an increase in pain relief and an increase in the level of numbness. This injection of saline in the epidural space to increase pain relief and numbness is termed epidural volume extension (EVE).

Thus far, studies on EVE have all been done in patients undergoing surgery with spinal anesthesia and not solely for analgesia. The purpose of this study is to determine if there is a benefit for EVE to improve labor analgesia (pain relief) using CSE. We will study 60 women requesting labor pain relief. Half these women will receive a CSE without EVE, which is the present standard of care. The other half will receive a CSE with 10 ml of saline for EVE before inserting the epidural catheter. We will then determine if there is a benefit for EVE by observing for a difference between the two groups with respect to the level of numbness, the amount and speed of pain relief and the intensity of leg weakness. We hypothesize that injecting 10 ml of saline for EVE using CSE may improve the amount and speed of pain relief while decreasing side effects such as leg weakness. If there were a benefit to EVE, this would be a simple and inexpensive method for improving pain relief in laboring women.

Conditions

Pregnancy; Labor Pain

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

Epidural Volume Extension

CSE with 10 ml EVE

Group Type: EXPERIMENTAL

CSE with 10 ml EVE

Intervention Type: PROCEDURE

Combined Spinal-Epidural (CSE) with 10 ml Epidural Volume Extension (EVE)

No Epidural Volume Extension

CSE without EVE

Group Type: ACTIVE_COMPARATOR

CSE without EVE

Intervention Type: PROCEDURE

Combined Spinal-Epidural (CSE) without Epidural Volume Extension (EVE)

Interventions

CSE with 10 ml EVE

Combined Spinal-Epidural (CSE) with 10 ml Epidural Volume Extension (EVE)

Intervention Type: PROCEDURE

CSE without EVE

Combined Spinal-Epidural (CSE) without Epidural Volume Extension (EVE)

Intervention Type: PROCEDURE

Other Intervention Names

Normal Saline

Eligibility Criteria

Inclusion Criteria

• Nulliparous parturients requesting regional analgesia for labour pain with singleton, vertex presentation fetuses at 37-42 week gestation in active labor with cervical dilation < 5 cm.
• American Society of Anesthesia physical status class I & II (ASA I - Healthy, ASA II - mild and controlled systemic disease, e.g. controlled essential hypertension)
• Age ≥ 18 years (Standard within the obstetrical anesthesia literature)
• English-speaking

Exclusion Criteria

• Contraindications to neuraxial analgesia (i.e. coagulopathy, systemic infection, neuropathy)
• Conditions associated with abnormal spinal anatomy which can affect local anesthetic spread (i.e. scoliosis, spina bifida, spinal instrumentation)
• Conditions associated with an increased risk of a cesarean delivery (i.e., history of uterine anomaly or surgery, morbid obesity (Body Mass Index ≥ 35 kg/m2)
• Clinically significant diseases of pregnancy such as pregnancy-induced hypertension or preeclampsia (defined as systolic blood pressure (SBP) > 160mmHg, diastolic blood pressure (DBP) > 110mmHg and/or requiring antihypertensive treatment or associated with significant proteinuria)
• Severe maternal cardiac disease
• Known fetal anomalies /intrauterine fetal demise
• Patient enrollment in another study involving a study medication within 30 days
• Any other physical or psychiatric condition which may impair their ability to cooperate with study data collection

• Minimum Eligible Age: 18 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

IWK Health Centre

OTHER

Sponsor Role: lead

Responsible Party

Ronald George

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Valerie Zaphiratos, MSc MD FRCPC

Role: PRINCIPAL_INVESTIGATOR

IWK Health Centre

Ronald B George, MD FRCPC

Role: PRINCIPAL_INVESTIGATOR

IWK Health Centre

Locations

Women's and Obstetric Anesthesia, IWK Health Centre

Halifax, Nova Scotia, Canada

Countries

Canada

References

Zaphiratos V, George RB, Macaulay B, Bolleddula P, McKeen DM. Epidural Volume Extension During Combined Spinal-Epidural Labor Analgesia Does Not Increase Sensory Block. Anesth Analg. 2016 Sep;123(3):684-9. doi: 10.1213/ANE.0000000000001281.

Reference Type: DERIVED

PMID: 27088994 (View on PubMed)

Other Identifiers

IWK - 1013037

Identifier Type: -

Identifier Source: org_study_id