Programmed Intermittent Epidural Bolus Versus Continuous Epidural Infusion for Termination of Pregnancy Analgesia

NCT ID: NCT01860521

Last Updated: 2013-10-28

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

104 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-09-30

Study Completion Date

2013-06-30

Brief Summary

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This study included women who underwent voluntary second trimester termination of pregnancy. Patients were randomized to programmed intermittent epidural anesthetic bolus or continuous epidural infusion for pain analgesia. In this randomized, double-blind study, the investigators assess the incidence of motor block (primary outcome), degree of satisfaction of the patients, total levobupivacaine and sufentanil consumption and adverse events (secondary outcomes) between the two study groups.

Detailed Description

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Conditions

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Medical; Abortion, Fetus

Keywords

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Termination of pregnancy Second trimester Programmed intermittent epidural bolus Continuous epidural infusion Epidural analgesia Legally Induced Abortion

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Programmed Intermittent Epidural Bolus

Group Type ACTIVE_COMPARATOR

Programmed Intermittent Epidural Bolus

Intervention Type PROCEDURE

An initial epidural loading dose consisting of 0.0625% levobupivacaine 20 mL (Chirocaine®, Abbott, Chicago, USA) plus sufentanil 10 µg (Fentatienil®, Angelini, Rome, Italy) was followed by 0.0625% levobupivacaine with sufentanil 0.5 µg/mL, 10 mL every hour, starting 60 minutes after the administration of the initial epidural loading dose until expulsion of the fetus. If the patient still felt pain (VAPS score ≥ 30mm), despite the analgesia, additional manual incremental boluses of 5-mL levobupivacaine 0.125% until the VAPS score was \< 30 mm were administered.

Procedure of interruption of pregnancy

Intervention Type PROCEDURE

Patients were administered 1 mg of gemeprost pessaries (Cervidil®, Merck Serono SPA, Roma, Italy) in the posterior fornix of the vagina every 3 hours up to 5 doses. If the expulsion of the fetus did not occur, the therapeutic regimen was repeated after 24 hours from the initiation of the treatment. Induction-to-abortion time (hours) was considered the period of time comprised between the first gemeprost pessary administration and fetal expulsion. Failure of induction of abortion was defined as women undelivered after two completed cycles (48h).The evacuation of the uterus under general anesthesia was performed if ultrasonography showed retained productions of conception.

Drug used for analgesia procedures

Intervention Type DRUG

Levobupivacaine (Chirocaine®, Abbott, Chicago, IL, USA) and sufentanil(Fentatienil®, Angelini, Rome, Italy) were administered in both study groups according to the regimen of each intervention arm (Programmed Intermittent Epidural Bolus Versus Continuous Epidural Infusion).

Pump for programmed intermittent bolus.

Intervention Type DEVICE

Pump administering programmed intermittent epidural bolus for the maintenance of analgesia was used.

Drug used for termination of pregnancy procedure.

Intervention Type DRUG

Gemeprost pessaries.

Continuous Epidural Infusion

Group Type ACTIVE_COMPARATOR

Continuous Epidural Infusion

Intervention Type PROCEDURE

An initial epidural loading dose consisting of 0.0625% levobupivacaine 20 mL (Chirocaine®, Abbott, Chicago, USA) plus sufentanil 10 µg (Fentatienil®, Angelini, Rome, Italy) was followed by 0.0625% levobupivacaine with sufentanil 0.5 µg/mL at a rate of 10 mL/h, starting 60 minutes after the administration of the initial epidural loading dose until expulsion of the fetus. If the patient still felt pain (VAPS score ≥ 30mm), despite the analgesia, additional manual incremental boluses of 5-mL levobupivacaine 0.125% until the VAPS score was \< 30 mm were administered.

Procedure of interruption of pregnancy

Intervention Type PROCEDURE

Patients were administered 1 mg of gemeprost pessaries (Cervidil®, Merck Serono SPA, Roma, Italy) in the posterior fornix of the vagina every 3 hours up to 5 doses. If the expulsion of the fetus did not occur, the therapeutic regimen was repeated after 24 hours from the initiation of the treatment. Induction-to-abortion time (hours) was considered the period of time comprised between the first gemeprost pessary administration and fetal expulsion. Failure of induction of abortion was defined as women undelivered after two completed cycles (48h).The evacuation of the uterus under general anesthesia was performed if ultrasonography showed retained productions of conception.

Drug used for analgesia procedures

Intervention Type DRUG

Levobupivacaine (Chirocaine®, Abbott, Chicago, IL, USA) and sufentanil(Fentatienil®, Angelini, Rome, Italy) were administered in both study groups according to the regimen of each intervention arm (Programmed Intermittent Epidural Bolus Versus Continuous Epidural Infusion).

Pump for continuous epidural infusion.

Intervention Type DEVICE

Pump administering continuous epidural infusion for the maintenance of analgesia was used.

Drug used for termination of pregnancy procedure.

Intervention Type DRUG

Gemeprost pessaries.

Interventions

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Programmed Intermittent Epidural Bolus

An initial epidural loading dose consisting of 0.0625% levobupivacaine 20 mL (Chirocaine®, Abbott, Chicago, USA) plus sufentanil 10 µg (Fentatienil®, Angelini, Rome, Italy) was followed by 0.0625% levobupivacaine with sufentanil 0.5 µg/mL, 10 mL every hour, starting 60 minutes after the administration of the initial epidural loading dose until expulsion of the fetus. If the patient still felt pain (VAPS score ≥ 30mm), despite the analgesia, additional manual incremental boluses of 5-mL levobupivacaine 0.125% until the VAPS score was \< 30 mm were administered.

Intervention Type PROCEDURE

Continuous Epidural Infusion

An initial epidural loading dose consisting of 0.0625% levobupivacaine 20 mL (Chirocaine®, Abbott, Chicago, USA) plus sufentanil 10 µg (Fentatienil®, Angelini, Rome, Italy) was followed by 0.0625% levobupivacaine with sufentanil 0.5 µg/mL at a rate of 10 mL/h, starting 60 minutes after the administration of the initial epidural loading dose until expulsion of the fetus. If the patient still felt pain (VAPS score ≥ 30mm), despite the analgesia, additional manual incremental boluses of 5-mL levobupivacaine 0.125% until the VAPS score was \< 30 mm were administered.

Intervention Type PROCEDURE

Procedure of interruption of pregnancy

Patients were administered 1 mg of gemeprost pessaries (Cervidil®, Merck Serono SPA, Roma, Italy) in the posterior fornix of the vagina every 3 hours up to 5 doses. If the expulsion of the fetus did not occur, the therapeutic regimen was repeated after 24 hours from the initiation of the treatment. Induction-to-abortion time (hours) was considered the period of time comprised between the first gemeprost pessary administration and fetal expulsion. Failure of induction of abortion was defined as women undelivered after two completed cycles (48h).The evacuation of the uterus under general anesthesia was performed if ultrasonography showed retained productions of conception.

Intervention Type PROCEDURE

Drug used for analgesia procedures

Levobupivacaine (Chirocaine®, Abbott, Chicago, IL, USA) and sufentanil(Fentatienil®, Angelini, Rome, Italy) were administered in both study groups according to the regimen of each intervention arm (Programmed Intermittent Epidural Bolus Versus Continuous Epidural Infusion).

Intervention Type DRUG

Pump for programmed intermittent bolus.

Pump administering programmed intermittent epidural bolus for the maintenance of analgesia was used.

Intervention Type DEVICE

Pump for continuous epidural infusion.

Pump administering continuous epidural infusion for the maintenance of analgesia was used.

Intervention Type DEVICE

Drug used for termination of pregnancy procedure.

Gemeprost pessaries.

Intervention Type DRUG

Other Intervention Names

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Levobupivacaine: Chirocaine®, Abbott, Chicago, IL, USA. Sufentanil: Fentatienil®, Angelini, Rome, Italy. Pump: Gemstar®; Hospira, Lake Forest, USA. Pump: Gemstar®; Hospira, Lake Forest, USA. Gemeprost pessaries: Cervidil®, Merck Serono SPA, Rome, Italy.

Eligibility Criteria

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Inclusion Criteria

* age ≥ 18 years
* pregnancy at second trimester
* willingness of voluntary interrupt the pregnancy
* comprehension of Italian Language
* baseline pain score ≥ 30 on a 100-mm visual analog pain scale (VAPS)

Exclusion Criteria

* contraindication to epidural analgesia and to narcotics
* history of drug abuse or chronic use
* maternal disease (such as severe asthma, cardiac, liver or kidney disease)
* inability to comprehend or comply with the analgesia pain management procedures.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy

OTHER

Sponsor Role lead

Responsible Party

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Umberto Leone Roberti Maggiore

Principal Investigator, Research Fellow.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Simone Ferrero, PhD

Role: STUDY_DIRECTOR

Universita degli Studi di Genova

Umberto Leone Roberti Maggiore, MD

Role: PRINCIPAL_INVESTIGATOR

Universita degli Studi di Genova

Locations

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Department of Obstetrics and Gynecology, San Martino Hospital and National Institute for Cancer Research, University of Genoa

Genoa, Ligury, Italy

Site Status

Countries

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Italy

Other Identifiers

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SCUL 4022

Identifier Type: -

Identifier Source: org_study_id