Insufficient Regional Anesthesia and Conversion to General Anesthesia for Cesarean Section A Qualitative Multicenter Study

NCT ID: NCT06669156

Last Updated: 2025-08-27

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

RECRUITING

Total Enrollment

30 participants

Study Classification

OBSERVATIONAL

Study Start Date

2025-02-01

Study Completion Date

2027-01-01

Brief Summary

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Background In Denmark, approximately 20% of all children are born via cesarean section (C-section), making it the most common surgical procedure (also internationally). The recommended anesthesia for cesarean sections is regional anesthesia (spinal or epidural, "spinal anesthesia"), as it has several advantages: the woman is awake and experiences the delivery of her child, she maintains spontaneous breathing (the risk of difficult airway management is significantly higher in pregnant women), and the risk of aspiration of stomach contents into the lungs (which is clearly increased in pregnant women) is reduced. Furthermore, regional anesthesia can contribute to early postoperative pain management to some extent.

With spinal anesthesia, most women feel pressure and touch but no pain during the cesarean section. However, some women do experience pain during the procedure, necessitating a change in the plan. If inadequate anesthesia is detected before the surgery begins, one may choose (depending on, for example, the urgency of the cesarean) to administer renewed regional anesthesia (typically an epidural). However, if the woman first experiences pain after the surgery has commenced, it is necessary to place her under general anesthesia for the remainder of the procedure. Experience shows that this process can be challenging, and there are frequent examples in clinical practice of inappropriate courses of action, where women have experienced unacceptable pain during their cesarean sections without being placed under general anesthesia. It is difficult to obtain an exact figure on how many women experience inadequate anesthesia during cesarean sections under regional anesthesia, as not all cases are recognized or followed up on. Studies indicate that up to 12% experience pain during a cesarean section.

The consequences of inadequate anesthesia for cesarean sections can be quite significant for women, including impaired bonding with the child, poorer establishment of breastfeeding, increased risk of postpartum reactions and post-traumatic stress, as well as (anecdotally) the risk of women opting out of future pregnancies, as they may be reluctant to subject themselves to a similar situation again.

Aim The aim of this study is to investigate how women experience insufficient regional anesthesia during cesarean sections that require conversion to general anesthesia. The focus is on exploring the factors that contribute positively and negatively to the woman's experience in this situation.

Method Qualitative study in six Danish hospitals.

Inclusion criteria:

* Women undergoing elective or emergency cesarean section, aged over 17 years
* Regional (spinal or epidural or combined epidural-spinal) anesthesia converted to general anesthesia intraoperatively (i.e., after surgery has commenced) due to insufficient regional anesthesia (i.e., not for obstetric indications, such as in cases of difficult fetal extraction)

Exclusion criteria:

* Does not speak Danish or English
* Does not wish to participate

The woman will be contacted for the first time on day 1 or 2 after the cesarean section (before she is discharged from the hospital). She will be informed about the project and invited to participate. As a potential project participant, she is entitled to a 24-hour consideration period, and if desired, a new contact will be arranged for the following day. If she wishes to participate, she will be contacted again after 3 months. At this time, she will receive a call to schedule a follow-up telephone interview within a few days. This will take place as a semi-structured interview, initiated with open questions and concluded with a few more specific questions. At the end of the interview, a screening for post-traumatic stress will be conducted using the PTSD-8 tool. Follow-up interviews will be recorded digitally and transcribed verbatim.

Sample Size The project encompasses all women at the participating centers who experience insufficient regional anesthesia during a cesarean section and conversion to general anesthesia during 1 year.

Detailed Description

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Conditions

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Cesarean Section Complications Cesarean Section Pain Regional Anesthesia

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Partuients experiencing conversion of regional to general anesthesia for cesarean section

All parturients undergoing emergency or elective cesarean section in a participating hospital, who experience insufficient regional anesthesia and conversion to general anesthesia during the 1 year inclusion period

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Women undergoing elective or emergency cesarean section, aged over 17 years
* Regional (spinal or epidural or combined epidural-spinal) anesthesia converted to general anesthesia intraoperatively (i.e., after surgery has commenced) due to insufficient regional anesthesia (i.e., not for obstetric indications, such as in cases of difficult fetal extraction)

Exclusion Criteria

* Does not speak Danish or English
* Does not wish to participate
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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University Hospital of North Zealand

UNKNOWN

Sponsor Role collaborator

Copenhagen University Hospital at Herlev

OTHER

Sponsor Role collaborator

Aalborg University Hospital

OTHER

Sponsor Role collaborator

Copenhagen University Hospital, Denmark

OTHER

Sponsor Role collaborator

Zealand University Hospital

OTHER

Sponsor Role collaborator

Sygehus Lillebaelt

OTHER

Sponsor Role lead

Responsible Party

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Helene Korvenius Nedergaard

MD, PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Viborg Hospital

Viborg, Region Midt, Denmark

Site Status RECRUITING

Aalborg Hospital

Aalborg, , Denmark

Site Status RECRUITING

Rigshospitalet, Copenhagen University Hospital

Copenhagen, , Denmark

Site Status RECRUITING

Herlev Hospital

Herlev, , Denmark

Site Status RECRUITING

Hillerød Hospital

Hillerød, , Denmark

Site Status RECRUITING

Lillebaelt Hospital, Kolding

Kolding, , Denmark

Site Status RECRUITING

Roskilde Hospital

Roskilde, , Denmark

Site Status RECRUITING

Countries

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Denmark

Central Contacts

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Helene K Nedergaard, MD, PhD

Role: CONTACT

+4553272244

Facility Contacts

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Janne Lund Olesen, MD

Role: primary

+4529440868

Malene L Abildgren, MD

Role: primary

+4520987473

Kim Ekelund, MD, PhD

Role: primary

+4527285042

Kim Wildgaard, MD, PhD

Role: primary

+4538683868

Patricia Duch, MD

Role: primary

+4528572814

Helene K Nedergaard, MD, PhD

Role: primary

+4553272244

Anne Wikkelsø, MD, PhD

Role: primary

+4522612152

Other Identifiers

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24/67884

Identifier Type: -

Identifier Source: org_study_id

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