- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01119079
Study to Determine Whether the Instillation of 10ml Normal Saline Improves Epidural Analgesia During Labor
A Randomized, Prospective Study to Establish Whether the Instillation of 10ml of Epidural Normal Saline Improves the Quality Of Epidural Analgesia During Labor
In current obstetric anesthesia practice, epidural analgesia is the most effective technique to control labor pain for those women who request pain-free delivery. Epidural analgesia not only allows us to obtain greater pain relief and increased satisfaction of mothers, but also permits us to convert it to regional anesthesia in case of operative delivery, avoiding general anesthesia.
One of the major concerns with epidural anesthesia in labor setting is the inability to produce an intensive analgesia or adequate level to proceed with cesarean section. This study is designed to examine the hypothesis that 10ml epidural normal saline to reduce rate of one-side block, low segmental block, and patch block, and improve quality of labor epidural analgesia/ anesthesia in obstetric population.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
One of the major concerns with epidural anesthesia in labor setting is the inability to produce an intensive analgesia or adequate level to proceed with cesarean section. The incidence of this event is rather various among reports, reflecting variability in definitions, authors' clinical judgment and perception, practice parameters, hospital settings. In most of related studies, the term of incomplete block was used and defined as (1) unilateral block; (2) unblocked sacral segments; (3) low level; (4) unblocked segments or a patchy block. 1Reported incidence of inadequate analgesia/anesthesia was 18% to 31.8%. In addition, the reported incidence of intraoperative discomfort/visceral pain was from 10% to 56%.1
If the anesthesia/analgesia is not adequate, other treatment modalities have to be provided to improve pain relief, these include intravenous narcotics or ketamine, replacements of epidural catheter, or general anesthesia, the risks of complications may be increased by those managements.
The etiology and mechanisms of failed or dysfunctional epidural analgesia or anesthesia in obstetrics are complex, multifactorial, and not entirely understood. Depending on the situation, the causes might be evident or puzzling and difficult to explain.
Injection of fluid is frequently used for identification of the epidural space by the loss-of-resistance (LOR) technique. It has been shown that different volumes of saline may affect the subsequent epidural analgesia. Iwama showed that using 10 mL of saline as compared to two mL in patients undergoing elective surgery during lumbar epidural anesthesia with 2% mepivacaine resulted in a greater extent of anesthesia.2 Also, Okutomi et al examined the effect of saline volume on anesthetic levels and quality of thoracic epidural block in patients undergoing upper abdominal surgery. They demonstrated that the block level for cold after mepivacaine 1.5% was proportional to the saline volume injected, whereas the block level for pain was independent of the saline solution.3 Identifying the epidural space by a lost of resistance to air method is thought to increase the incidence of inadequate anesthesia. A randomized study, comparing air versus saline to identify the epidural space in parturients, found a higher incidence of inadequate analgesia in the air group (36% versus 19%).4
In parturients requesting epidural analgesia, a few studies showed that 2- 10ml normal saline giving to epidural space after LOR was obtained reduced the rate of venous puncture and unblock segments to cold and pin prick, but did not improve the visual analog pain scale or reduced the need for supplemental.3,5,6 No study on improvement of unilateral block, patch block and patients' satisfaction in obstetric setting has been found.
We design this study to examine the hypothesis that 10ml epidural normal saline to reduce rate of one-side block, low segmental block, and patch block, and improve quality of labor epidural analgesia/ anesthesia in obstetric population.
Study Type
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
New Jersey
-
Newark, New Jersey, United States, 07101
- University Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- American Society of Anesthesiologists class I-II term parturients with singleton vertex presentation in active labor
- Patients who have cervical dilatation between 3 and 7 centimeters
Exclusion Criteria:
• Patients with contraindications to epidural analgesia,
- severe medical or obstetric complications,
- morbid obesity (body mass index >40 kg/m2),
- history of drug or alcohol abuse,
- abnormal hepatic (AST/ALT), renal (creatinine levels), or hematological (PTT levels) test results.
- presence of blood on the second insertion into the intervertebral space
- presence of cerebral spinal fluid upon insertion into the intervertebral space
- subjects who deliver (either vaginally or via cesarean section) within 2 hours of the epidural insertion
- subjects less than 36 weeks gestation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Standard labor epidural protocol
|
Standard procedure
|
Experimental: 10ml Normal Saline prior to lidocaine
|
10ml Normal Saline instilled in the epidural space
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
improve quality of labor epidural analgesia/ anesthesia in obstetric population.
Time Frame: Administration of epidural anesthesia + 2 hours
|
Administration of epidural anesthesia + 2 hours
|
Collaborators and Investigators
Investigators
- Principal Investigator: Dongchen Li, MD, PhD, Umdnj-Njms
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 0120090228
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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