Plasmatic Catecholamines: Randomized Controlled Trial Comparing Epidural Versus Combined Spinal-epidural

NCT ID: NCT02666794

Last Updated: 2022-03-08

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

COMPLETED

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-07-12

Study Completion Date

2020-10-16

Brief Summary

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Combined spinal-epidural (CSE) for labor analgesia has been associated with fetal bradycardia and uterine hypertonia, possibly due to asymmetric decrease in catecholamine levels, when compared with epidural analgesia (EP).

Detailed Description

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Background: Combined spinal-epidural technique for labor analgesia has been associated with fetal bradycardia and uterine hypertonia, when compared with epidural analgesia, possibly due to asymmetric decrease in catecholamine levels (epinephrine and norepinephrine) following neuraxial block. However, there are no studies comparing plasmatic catecholamine levels between those two techniques. This study aimed to compare spinal-epidural versus epidural regarding pre and post-analgesia catecholamine levels, uterine tone and fetal heart rate.

Methods: Randomized clinical trial with 47 laboring patients divided in two groups. Primary outcome was plasmatic catecholamine measurements before and after neuraxial block. Secondary outcomes were fetal heart rate changes, uterine hypertonia, hypotension episodes, pain relief and fetal outcomes.

Conditions

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Fetal Bradycardia Hypertonic Uterine Catecholamines

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Puncture epidural

Women in labor the epidural group will receive epidural bupivacaine with vasoconstrictor 0.125% 10 ml plus 20 micrograms sufentanil, followed by the placement of the epidural catheter

Group Type ACTIVE_COMPARATOR

Epidural bupivacaine with vasoconstrictor 0.125%

Intervention Type DRUG

10 ml

Epidural sufentanil

Intervention Type DRUG

20 mcg

Placement of the epidural catheter

Intervention Type PROCEDURE

Placement of the epidural catheter

Puncture combined spinal-epidural

The mothers of the combined spinal-epidural analgesia group will receive intrathecal hyperbaric bupivacaine solution 0.5% 2.5 mg plus 5.0 micrograms of sufentanil and plus 60 micrograms of morphine, followed by placement of an epidural catheter to the catheter through technical needle

Group Type ACTIVE_COMPARATOR

Intrathecal hyperbaric bupivacaine solution 0.5%

Intervention Type DRUG

2.5 mg

Intrathecal morphine

Intervention Type DRUG

60 mcg

Placement of an epidural catheter to the catheter through technical needle

Intervention Type PROCEDURE

Placement of an epidural catheter to the catheter through technical needle

Intrathecal sufentanil

Intervention Type DRUG

5 mcg

Interventions

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Epidural bupivacaine with vasoconstrictor 0.125%

10 ml

Intervention Type DRUG

Epidural sufentanil

20 mcg

Intervention Type DRUG

Placement of the epidural catheter

Placement of the epidural catheter

Intervention Type PROCEDURE

Intrathecal hyperbaric bupivacaine solution 0.5%

2.5 mg

Intervention Type DRUG

Intrathecal morphine

60 mcg

Intervention Type DRUG

Placement of an epidural catheter to the catheter through technical needle

Placement of an epidural catheter to the catheter through technical needle

Intervention Type PROCEDURE

Intrathecal sufentanil

5 mcg

Intervention Type DRUG

Eligibility Criteria

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Exclusion Criteria

Contraindications to interventions, either due to severe comorbidity or contraindication to neuraxial block; previous use of systemic opioids during labor, maternal amniotic infection or known fetal diseases
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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University of Sao Paulo General Hospital

OTHER

Sponsor Role lead

Responsible Party

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SHIRLEY ANDRADE SANTOS

Anesthesiologist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Shirley Santos, MD

Role: PRINCIPAL_INVESTIGATOR

Anesthesiologist

Locations

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Shirley Andrade Santos

São Paulo, , Brazil

Site Status

Countries

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Brazil

References

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Baschat AA. Fetal growth restriction - from observation to intervention. J Perinat Med. 2010 May;38(3):239-46. doi: 10.1515/jpm.2010.041.

Reference Type BACKGROUND
PMID: 20205623 (View on PubMed)

Abrao KC, Francisco RPV, Miyadahira S, Cicarelli DD, Zugaib M. Elevation of uterine basal tone and fetal heart rate abnormalities after labor analgesia: a randomized controlled trial. Obstet Gynecol. 2009 Jan;113(1):41-47. doi: 10.1097/AOG.0b013e31818f5eb6.

Reference Type RESULT
PMID: 19104358 (View on PubMed)

Van de Velde M, Vercauteren M, Vandermeersch E. Fetal heart rate abnormalities after regional analgesia for labor pain: the effect of intrathecal opioids. Reg Anesth Pain Med. 2001 May-Jun;26(3):257-62. doi: 10.1053/rapm.2001.22258.

Reference Type RESULT
PMID: 11359226 (View on PubMed)

Nielsen PE, Erickson JR, Abouleish EI, Perriatt S, Sheppard C. Fetal heart rate changes after intrathecal sufentanil or epidural bupivacaine for labor analgesia: incidence and clinical significance. Anesth Analg. 1996 Oct;83(4):742-6. doi: 10.1097/00000539-199610000-00014.

Reference Type RESULT
PMID: 8831313 (View on PubMed)

Collis RE, Davies DW, Aveling W. Randomised comparison of combined spinal-epidural and standard epidural analgesia in labour. Lancet. 1995 Jun 3;345(8962):1413-6. doi: 10.1016/s0140-6736(95)92602-x.

Reference Type RESULT
PMID: 7760614 (View on PubMed)

Nakamura G, Ganem EM, Rugolo LM, Castiglia YM. Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia. Rev Assoc Med Bras (1992). 2009 Jul-Aug;55(4):405-9. doi: 10.1590/s0104-42302009000400014.

Reference Type RESULT
PMID: 19750306 (View on PubMed)

Patel NP, El-Wahab N, Fernando R, Wilson S, Robson SC, Columb MO, Lyons GR. Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study. Anaesthesia. 2014 May;69(5):458-67. doi: 10.1111/anae.12602.

Reference Type RESULT
PMID: 24738803 (View on PubMed)

Simmons SW, Taghizadeh N, Dennis AT, Hughes D, Cyna AM. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev. 2012 Oct 17;10(10):CD003401. doi: 10.1002/14651858.CD003401.pub3.

Reference Type RESULT
PMID: 23076897 (View on PubMed)

Other Identifiers

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45992815000000068

Identifier Type: -

Identifier Source: org_study_id

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