- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00990574
A Study Comparing Two Spinal Techniques for for Cesarean Delivery Anesthesia
Spinal Anesthesia for Cesarean Delivery: The Wiley Spinal Catheter Intermittent Bolus Technique Versus Single Shot Spinal Anesthesia
The purpose of this study is to compare single shot versus sequential bolus spinal technique via a catheter in patients undergoing Cesarean Section. We aim to determine which technique results in less blood pressure reduction and subsequent vasopressor use.
Other study endpoints include the incidence of maternal post dural puncture headaches and nausea and vomiting. In addition blood and CSF will be collected to see if biochemical mediators are related to wound hyperalgesia and healing.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Following IRB approval, the investigators plan to enroll 60 pregnant women (30 in the spinal anesthesia group (SAG), and 30 patients in the Wiley spinal catheter group (WSCG)) undergoing cesarean delivery. Patients will be randomly assigned to one of these two groups.
Both groups will undergo the standard procedures involved in placement of a spinal anesthetic in the sitting position. The SAG will have their drugs dosed intrathecally as a "single shot" while still in the sitting position. The WSCG will have a Wiley spinal catheter placed, but it will not be dosed until the patient is in the supine position with left uterine displacement. Both groups will be dosed with 12 mg of 0.75% hyperbaric bupivacaine, 10 mcg of fentanyl, and 100 mcg of morphine. While the SAG will receive their total dose as a one time bolus, the WSCG patients will receive the medication in sequential doses.
Blood pressure will be monitored every minute after spinal medication is administered until delivery of the baby. Thereafter, it will be monitored at least every 3 minutes. Any blood pressure below 90, 80 and 70% of baseline will be treated with 50, 100 and 150 mcg of phenylephrine, respectively.
In the WSC group, cerebrospinal fluid (CSF) will be collected prior to intrathecal dosing, and then 1 and 5 hours post-spinal utilizing a three-way stopcock incorporated into the IT catheter.
All CSF samples will be analyzed for various nociceptive and inflammatory biochemical mediators using a multiplex bead array immunoassay plate. Venous blood will be drawn prior to spinal dosing and 5 hours afterwards to measure the same cytokines and biochemical mediators.
Participants will be followed for 2 days post cesarean section to monitor for episodes of a spinal or post dural puncture headache (PDPH). A PDPH is defined as an occipital or frontal headache brought on by the erect posture and relieved when the supine posture is assumed. If the PDPH persists longer than 24 h with the same severity, an epidural blood patch (EBP) will be performed. The decision to perform an EBP will always be made by a staff anesthesiologist. Headaches will be monitored daily for 3 days, then at 1 week. Patients will be treated for their headaches per standard methods by an anesthesiologist not involved in the study.
Postoperative pain will be recorded at rest and sitting at 1, 5, 24, 48h post-cesarean using a VPS 0-10 (0=no pain, 10=worse pain imaginable) measure. The area of secondary hyperalgesia surrounding the wound will be measured at 48hours with a von Frey filament. A color laser Doppler will also be used to assess vascular perfusion of the wound 48 hours after surgery.
Study Type
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
California
-
Stanford, California, United States, 94305
- Stanford University School of Medicine
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- American Society of Anesthesiologists (ASA) Class I, II patients
- 18-45 year of age
- Uncomplicated singleton, term pregnancy
- Scheduled for Cesarean section
Exclusion Criteria:
- ASA class 3 and above
- Morbid obesity (BMI>40 kg/m2)
- Postpartum tubal ligation after cesarean
- Hypersensitivity and/or prior reaction to opioids
- Ineffective spinal
- Conversion to general anesthesia
- Multiple gestation pregnancy
- Emergency C-section
- Contraindication to regional anesthesia
- History of chronic opioid use
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: spinal anesthesia group (SAG)
Participants will undergo the standard procedures involved in placement of a spinal anesthetic in the sitting position.
|
The SAG (spinal anesthesia group) will have their drugs (12 mg of 0.75% hyperbaric bupivacaine, 10 mcg of fentanyl, and 100 mcg of morphine) dosed intrathecally as a "single shot" while still in the sitting position.
|
Active Comparator: The WSCG (wiley spinal catheter group)
The WSCG (wiley spinal catheter group) will undergo the standard procedures involved in placement of a spinal anesthetic in the sitting position.
|
The WSCG (wiley spinal catheter group) will have a Wiley spinal catheter placed, but it will not be dosed until the patient is in the supine position with left uterine displacement.
Participants will receive the medication (12 mg of 0.75% hyperbaric bupivacaine, 10 mcg of fentanyl, and 100 mcg of morphine) in sequential doses.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Blood pressure maintenance
Time Frame: Spinal to End Surgery
|
Spinal to End Surgery
|
Vasopressor use
Time Frame: Spinal to End Surgery
|
Spinal to End Surgery
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Post-spinal Headache
Time Frame: 1 week
|
1 week
|
Postoperative pain, wound hyperalgesia and perfusion
Time Frame: 48 h
|
48 h
|
CSF and blood biochemical nociceptive and inflammatory mediators
Time Frame: 5 h
|
5 h
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Brendan Carvalho, Stanford University
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- SU-10012009-4120
- 17492
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Headache
-
Canadian Memorial Chiropractic CollegeDr. Zaxx Co.UnknownMigraine Headache | Cervicogenic Headache | Tension-type HeadacheCanada
-
University GhentRecruitingTension-Type Headache | Cervicogenic Headache | Myofascial HeadacheBelgium
-
Real Centro Universitario Maria CristinaRecruiting
-
Brooke Army Medical CenterThe University of Queensland; The Defense and Veterans Brain Injury CenterRecruitingHeadache, Migraine | Persistent Post Traumatic Headache | Cervicogenic HeadacheUnited States
-
Uniformed Services University of the Health SciencesNational Institutes of Health (NIH); University of North Carolina, Chapel Hill and other collaboratorsRecruitingPost-Traumatic Headache Chronic Without Intractable HeadacheUnited States
-
University of WashingtonTerminatedChronic Post Traumatic HeadacheUnited States
-
University of AlbertaCompletedChronic Headache | Chronic Daily Headache | Analgesic Rebound Headache | Headache, IntractableCanada
-
University Hospital, GhentRecruitingMigraine Disorders | Headache Disorders | Tension-Type Headache | Cluster Headache | TACS | Secondary Headache DisorderBelgium
-
Meltem UzunCompletedExercise | Therapeutics | Headache, CervicogenicTurkey
-
Hospital of South West JutlandCompletedMedication-overuse Headache | Secondary Headache Disorders
Clinical Trials on Spinal Anesthesia Group (SAG)
-
Mingkwan Wongyingsinn, MDCompletedInflammation | Hernia | Anesthetics Adverse ReactionThailand
-
Fraser HealthNot yet recruitingAnesthesia, Spinal | Neurosurgery | Ropivacaine | BupivacaineCanada
-
Medipol UniversityCompletedPregnancy RelatedTurkey
-
Sao Jose do Rio Preto Medical SchoolUnknownHip Fractures | Knee Arthroplasty | Femur FractureBrazil
-
Pontificia Universidade Catolica de Sao PauloCompletedQuality of Life | Pain, Postoperative | Postoperative Complication | Personal SatisfactionBrazil
-
Shenandoah UniversityCompletedMusculoskeletal ManipulationsUnited States
-
National Taiwan University HospitalCompleted
-
Ain Shams UniversityCompleted
-
Jennifer BreelNoordwest Ziekenhuisgroep; Rijnstate Hospital; Diakonessenhuis, Utrecht; Alrijne...CompletedNeuropathic Pain | Failed Back Surgery SyndromeNetherlands
-
Northwestern UniversityIntuitapCompleted