Postpartum Perineal Pain After Obstetric Anal Sphincter Injuries

NCT ID: NCT03470675

Last Updated: 2025-12-09

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

PHASE4

Total Enrollment

67 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-06-27

Study Completion Date

2024-06-20

Brief Summary

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Obstetric anal sphincter injuries (OASIS) encompass both third and fourth degree perineal tears. These tears can have a significant impact on women's quality of life in the short and long term. One of the most distressing immediate complications of this severe perineal injury is perineal pain. Women can also experience postpartum depression, dyspareunia, and altered sexual function after OASIS.

This is a randomized controlled trial to study the effects of three interventions (placebo, low dose intravenous ketamine plus epidural morphine, or epidural morphine alone) on acute pain after OASIS.

The objective of this study is to assess the incidence of perineal pain in postpartum patients 1 week after obstetric anal sphincter injuries.

Detailed Description

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Conditions

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Pain Postpartum Depression

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Epidural saline + IV saline

Sterile saline via the epidural catheter. Sterile saline via intravenous catheter.

Group Type PLACEBO_COMPARATOR

Epidural saline + IV saline

Intervention Type DRUG

Sterile saline injection in the epidural catheter and in the intravenous catheter

Epidural morphine 3 mg + IV saline

3 milligrams morphine via the epidural catheter. Sterile saline via intravenous catheter.

Group Type ACTIVE_COMPARATOR

Epidural morphine 3 mg + IV saline

Intervention Type DRUG

Morphine 3 milligrams injection in the epidural catheter and sterile normal saline intravenous catheter

Epidural morphine 3 mg + IV ketamine 0.3 mg/kg

3 milligrams morphine via the epidural catheter. Ketamine 0.3 milligrams per kilogram via intravenous catheter.

Group Type ACTIVE_COMPARATOR

Epidural morphine 3 mg + IV ketamine 0.3 mg/kg

Intervention Type DRUG

Morphine 3 milligrams injection in the epidural catheter and 0.3 milligrams per kilogram weight infused in the intravenous catheter

Interventions

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Epidural saline + IV saline

Sterile saline injection in the epidural catheter and in the intravenous catheter

Intervention Type DRUG

Epidural morphine 3 mg + IV saline

Morphine 3 milligrams injection in the epidural catheter and sterile normal saline intravenous catheter

Intervention Type DRUG

Epidural morphine 3 mg + IV ketamine 0.3 mg/kg

Morphine 3 milligrams injection in the epidural catheter and 0.3 milligrams per kilogram weight infused in the intravenous catheter

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Age \>18 years of age
* English-speaking
* Vaginal delivery (spontaneous or assisted)
* A full-term fetus (\>37 weeks' gestation)
* OASIS as assessed by obstetrical provider
* Functional epidural analgesia at time of delivery
* Patient amenable to follow-up in specialty perineal clinic within the first week postpartum

Exclusion Criteria

* Previous pelvic surgery
* History of chronic pelvic pain
* History of recurrent urinary tract infections
* Women with known malformations of their urinary tract
* True allergies to ketamine and/or morphine
* Preeclampsia or hypertensive disorder at the time of delivery
* Obstructive sleep apnea
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Northwestern University

OTHER

Sponsor Role lead

Responsible Party

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Feyce M. Peralta, MD, MS

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Feyce Peralta, MD

Role: PRINCIPAL_INVESTIGATOR

Northwestern University

Locations

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Northwestern University

Chicago, Illinois, United States

Site Status

Countries

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United States

References

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Harvey MA, Pierce M, Alter JE, Chou Q, Diamond P, Epp A, Geoffrion R, Harvey MA, Larochelle A, Maslow K, Neustaedter G, Pascali D, Pierce M, Schulz J, Wilkie D, Sultan A, Thakar R; Society of Obstetricians and Gynaecologists of Canada. Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair. J Obstet Gynaecol Can. 2015 Dec;37(12):1131-48. doi: 10.1016/s1701-2163(16)30081-0.

Reference Type BACKGROUND
PMID: 26637088 (View on PubMed)

Macarthur AJ, Macarthur C. Incidence, severity, and determinants of perineal pain after vaginal delivery: a prospective cohort study. Am J Obstet Gynecol. 2004 Oct;191(4):1199-204. doi: 10.1016/j.ajog.2004.02.064.

Reference Type BACKGROUND
PMID: 15507941 (View on PubMed)

Chang SR, Chen KH, Lee CN, Shyu MK, Lin MI, Lin WA. Relationships between perineal pain and postpartum depressive symptoms: A prospective cohort study. Int J Nurs Stud. 2016 Jul;59:68-78. doi: 10.1016/j.ijnurstu.2016.02.012. Epub 2016 Feb 26.

Reference Type BACKGROUND
PMID: 27222452 (View on PubMed)

Bauchat JR, Higgins N, Wojciechowski KG, McCarthy RJ, Toledo P, Wong CA. Low-dose ketamine with multimodal postcesarean delivery analgesia: a randomized controlled trial. Int J Obstet Anesth. 2011 Jan;20(1):3-9. doi: 10.1016/j.ijoa.2010.10.002.

Reference Type BACKGROUND
PMID: 21224020 (View on PubMed)

Other Identifiers

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STU00206016

Identifier Type: -

Identifier Source: org_study_id

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