- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02149680
Long-term Effects of Accidental Dural Puncture in Patients Having Had an Epidural Blood Patch (LEAP) (LEAP)
Long-term Follow-up of Patients Having Had an Epidural Blood Patch Following Accidental Dural Puncture During Labour or Caesarean Section
Study Overview
Status
Detailed Description
A major risk with epidural analgesia (EDA) is accidental dural puncture (ADP). ADP occurs in approximately 1% of all pregnant women receiving EDA in connection with childbirth. Postdural puncture headache (PDPH) is the most common complication after ADP and affects approximately 86% of all mothers with ADP. Headache after ADP may be severe and sometimes affects the interaction between the newborn baby and the mother. The headaches are orthostatic which makes the patient bedridden, and are associated with symptoms such as nausea, vomiting, tinnitus and hearing changes. The symptoms are thought to represent leakage of cerebrospinal fluid (CSF), which in turn leads to reduced CSF volume and intracranial hypotension. These volume changes lead to traction of pain-sensitive intracranial structures. There are no studies in the literature that have either confirmed or visualized CSF leakage after ADP. The diagnosis of PDPH is solely based on clinical examination. There are over 50 different treatment options for PDPH. These treatments can be divided into conservative or invasive. Among others, the conservative treatment options include bed rest, caffeine and various pain medications. Several studies have shown the absence of a definite and curative effect of these treatment options. The most widely used invasive method for management of PDPH is epidural blood patch (EBP). EBP was first introduced in the 60's by applying three ml of the patients' own blood epidurally. Over the years, this volume has increased to at least 15-20 ml on the basis of case reports and studies with small number of participants and without any definite scientific evidence. However, EBP should not be applied sooner than 24 hours after the onset of accidental dura puncture, as the risk of failure is higher. Further studies are required in the literature to confirm the efficacy of EBP.
Additionally, the long term effects of EBP remain either unknown or vaguely understood. Are we treating an acute symptom with an invasive method, not knowing the long term sequelae? Since audiometric changes are known to result following ADP, can these changes persist over a long period of time? Therefore, we are interested in assessing the long term effects of EBP on backache, headache and audiometric changes in parturients who delivered during the years 2005 - 2011.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Stockholm, Sweden
- Karolinska Hospital
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Örebro, Sweden
- University Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Women in the age group 20-45 years
- Delivered during the years 2005-2011
- Region of Örebro and Stockholm, Sweden
Exclusion Criteria:
- Language difficulty
- Mental inadequacy
- Chronic backache or headache
- Pre-eclampsia during pregnancy
- Previous accidental dural puncture
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
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Experimental group
Patient who has had an epidural blood patch following accidental dura puncture during pregnancy
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Control Group
Women in the same group, equal numbers of those with or without epidurals, without accidental dural puncture, similar parity would constitute the control group.
They would be chose at random, 10 times the number in the experimental group (n = 600).
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Audiometric changes
Time Frame: 3 - 8 years after event
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Changes in oto-acoustic emission and tone-audiometry
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3 - 8 years after event
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Headache
Time Frame: During the last month
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Has the patient been affected by persistent or positional headaches, their character and localization
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During the last month
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Backache
Time Frame: Last 1 year
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Has the patient had problems with persistent backache that either prevents her from working full time, if there is any radiation of pain, its character and localization
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Last 1 year
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Collaborators and Investigators
Sponsor
Collaborators
Publications and helpful links
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
- LEAP-2013
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.
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