- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02278601
Comparison of Regimens MPIB, CIPCEA, PCEA (COLEUS)
October 2, 2023 updated by: KK Women's and Children's Hospital
Comparison of Modified Programmed Intermittent Bolus (MPIB), Computer-integrated Patient Controlled Epidural Analgesia (CIPCEA) and Conventional Patient Controlled Epidural Analgesia (PCEA) During Labour
Epidural analgesia is the gold standard of pain relief for labour pain.
Despite this, more than 50% of parturients continue to experience pain leading to suffering and increased caregiver workload.
Women who have increased pain tend to have lower successful patient bolus demands when patient controlled epidural analgesia (PCEA) is utilised and have dysfunctional labour requiring obstetric intervention such as Caesarean or instrumental delivery.
Labour pain often escalates and worsens as labour progresses requiring an individualized, variable, flexible analgesic regimen.
Bolus epidural administrations have been shown to improve uniform spread of local anaesthetics with better pain relief, compared to fixed background infusions.
Study Overview
Status
Active, not recruiting
Conditions
Intervention / Treatment
Detailed Description
The research team developed two novel epidural delivery regimens: computer-integrated PCEA (CIPCEA) and modified programmed intermittent bolus (MPIB) focused on individualization of analgesic requirements.
This phase 3 double-blinded randomized controlled trial will compare the two novel regimens, and each with conventional PCEA with basal infusion (BI), in reducing breakthrough pain (failure of the regimen to provide adequate pain relief, necessitating unscheduled epidural supplementation) incidence as the primary outcome in nulliparous term women requesting labour epidural analgesia.
In addition, a discrete choice experiment (DCE) in the format of a survey will be administered to estimate the women's preferences in treatment attributes related to epidural analgesia, including control over epidural dosage, chance of having breakthrough pain, motor block, instrumental delivery and out-of-pocket cost for epidural analgesia.
We will also look into the association model for breakthrough pain that would take into account pre-delivery factors to better understand the mechanism of breakthrough pain during labor process.
Study Type
Interventional
Enrollment (Actual)
839
Phase
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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-
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Singapore, Singapore, 229899
- KK Women's and Children's Hospital
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
21 years to 50 years (Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Healthy (ASA physical status 1 and 2) nulliparous parturients at term (≥36 weeks gestation);
- Singleton foetus
- Early labour (cervical dilation ≤5cm)
- Request labour epidural analgesia
- At least 21 years of age
Exclusion Criteria:
- parturients with multiple pregnancies
- non-cephalic foetal presentation
- obstetric (e.g. pre-eclampsia, premature rupture of amniotic membranes, gestational diabetes on insulin) and uncontrolled medical (e.g. cardiac disease) complications
- have contraindications to neuraxial blockade or have received parenteral opioids with the last 2 hours.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
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 |
---|---|
Experimental: MPIB modified programmed intermittent bolus
Modified programmed intermittent bolus (MPIB) up-down frequency of 5mls ropivacaine/fentanyl solution in bolus with epidural delivery system
|
epidural delivery system for maintenance of labour epidural analgesia using 0.1% ropivacaine (amide local anaesthetic) with 2mcg/ml fentanyl (opioid) as maintenance solution
epidural delivery system for maintenance of labour epidural analgesia using 0.1% ropivacaine (amide local anaesthetic) with 2mcg/ml fentanyl (opioid) as maintenance solution
Other Names:
epidural delivery system for maintenance of labour epidural analgesia using 0.1% ropivacaine (amide local anaesthetic) with 2mcg/ml fentanyl (opioid) as maintenance solution
Other Names:
|
Experimental: CIPCEA
computer integrated patient controlled epidural analgesia (CIPCEA) up-down variable basal infusion of ropivacaine/fentanyl solution with epidural delivery system
|
epidural delivery system for maintenance of labour epidural analgesia using 0.1% ropivacaine (amide local anaesthetic) with 2mcg/ml fentanyl (opioid) as maintenance solution
epidural delivery system for maintenance of labour epidural analgesia using 0.1% ropivacaine (amide local anaesthetic) with 2mcg/ml fentanyl (opioid) as maintenance solution
Other Names:
epidural delivery system for maintenance of labour epidural analgesia using 0.1% ropivacaine (amide local anaesthetic) with 2mcg/ml fentanyl (opioid) as maintenance solution
Other Names:
|
Active Comparator: patient controlled epidural analgesia with basal infusion
patient controlled epidural analgesia (PCEA) with fixed basal infusion of ropivacaine/fentanyl solution with epidural delivery system
|
epidural delivery system for maintenance of labour epidural analgesia using 0.1% ropivacaine (amide local anaesthetic) with 2mcg/ml fentanyl (opioid) as maintenance solution
epidural delivery system for maintenance of labour epidural analgesia using 0.1% ropivacaine (amide local anaesthetic) with 2mcg/ml fentanyl (opioid) as maintenance solution
Other Names:
epidural delivery system for maintenance of labour epidural analgesia using 0.1% ropivacaine (amide local anaesthetic) with 2mcg/ml fentanyl (opioid) as maintenance solution
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of subjects with Breakthrough pain
Time Frame: 1 day
|
Unscheduled epidural supplementation by anaesthetist due to pain
|
1 day
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of subjects with Caesarean section
Time Frame: 1 day
|
Number of subjects with Caesarean section
|
1 day
|
Number of subjects with Instrumental delivery
Time Frame: 1 day
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Number of subjects with Instrumental delivery (forceps, vacuum delivery)
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1 day
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Foetal outcome
Time Frame: 1 day
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APGAR scores
|
1 day
|
Willingness to pay
Time Frame: 1 day
|
Discrete choice experiments (DCE) in survey format will be given to patients to determine patient's mean willingness to pay for epidural features, including control over epidural dosage, chance of having breakthrough pain, motor block, instrumental delivery and out-of-pocket cost for epidural analgesia)
|
1 day
|
Factors associated with epidural decisions
Time Frame: 1 day
|
Participants will be exposed to 8 pairs of hypothetical medical scenarios as per the design of DCE.
Participants have to choose the ideal scenario (A or B) that provides the highest perceived benefits.
Each pair of scenarios represents a comprehensive combination of possible attributes related to epidural analgesia, including control over epidural dosage, chance of having breakthrough pain, motor block, instrumental delivery and out-of-pocket cost for epidural analgesia.
The most common factors associated with optimal perceived benefits will be assessed based on these experimental design.
A weighted estimate will be calculated for each attribute.
|
1 day
|
Pain vulnerability: Pain Catastrophizing Scale
Time Frame: 1 day
|
Assessment will be done via Pain Catastrophizing Scale (PCS) questionnaire before delivery.
Pain catastrophizing refers to the negative thought processes patients have when they are exposed to pain or painful experiences.
The PCS is a 13-item scale, with each item rated on a 5-point scale: 0 (Not at all) to 4 (all the time).
It is broken into three subscales being magnification (0-12), rumination (0-16), and helplessness (0-24).
A higher value in each subscale indicates a higher tendency to that subscale (worse outcome).
|
1 day
|
Edinburgh Postnatal Depression Scale before and after delivery
Time Frame: 5-9 weeks
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Assessment will be done via Edinburgh Postnatal Depression Scale (EPDS) before delivery, and again 5 to 9 weeks after delivery to assess patient's status on postnatal depression.
The EPDS is a 10 item self-reported questionnaire validated for use as a screening tool for antenatal and postpartum depression in the clinical setting.
Participants are asked to respond according to how they have felt in the past seven days, by which the questions correspond to common depressive symptoms.
Each item is measured on a 4-point scale, with a total score in the range of 0 to 30.
A higher total score indicates a greater degree of depressive symptoms.
A score of 13 and above indicates clinically significant depressive symptom.
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5-9 weeks
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Sub-acute pain after childbirth
Time Frame: 5-9 weeks
|
Assessment will be done via a pain survey at 5-9 weeks after delivery to ask on patient's pain experience, including the presence of sub-acute pain after childbirth, defined by presence or absence of pain that lasted for 4 weeks or more) (binary variable with categories "yes" or "no").
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5-9 weeks
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Ban L Sng, FANZCA, KK Women's and Children's Hospital
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
January 28, 2015
Primary Completion (Actual)
May 6, 2019
Study Completion (Estimated)
December 31, 2025
Study Registration Dates
First Submitted
October 26, 2014
First Submitted That Met QC Criteria
October 28, 2014
First Posted (Estimated)
October 30, 2014
Study Record Updates
Last Update Posted (Actual)
October 4, 2023
Last Update Submitted That Met QC Criteria
October 2, 2023
Last Verified
October 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pain
- Neurologic Manifestations
- Breakthrough Pain
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anesthetics, Intravenous
- Anesthetics, General
- Analgesics, Opioid
- Narcotics
- Adjuvants, Anesthesia
- Anesthetics
- Fentanyl
- Anesthetics, Local
- Ropivacaine
Other Study ID Numbers
- CTGL13feb013
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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