Conversion of Labor Analgesia for Intrapartum Cesarean Delivery: DPE v CSE v Epidural

August 31, 2026 updated by: Emily E. Sharpe, M.D., Mayo Clinic

Conversion of Labor Analgesia for Intrapartum Cesarean Delivery: Dural Puncture Epidural vs Combined Spinal Epidural vs Epidural

As the dural puncture epidural (DPE) is increasing in popularity for labor analgesia, it is important to understand how it impacts outcomes in parturients. Prior studies have found epidural catheters placed via the combined-spinal epidural technique have greater success at surgical conversion for cesarean delivery than catheters placed via traditional techniques. The investigators aim to determine if epidural catheters placed by a DPE technique will also have an increased successful conversion for surgical anesthesia by conducting a retrospective review of all CD during the study period. If an association is found, this could be another benefit of DPE for labor analgesia.

Study Overview

Status

Enrolling by invitation

Conditions

Intervention / Treatment

Detailed Description

Electronic medical records will be searched for all intrapartum cesarean deliveries performed from February 1, 2017 through May 30, 2021 (Mayo Clinic) and from January 1, 2022 to December 31, 2022 (BC Women's Hospital).

From this list, patients that had cesarean delivery with an epidural catheter will be identified and split into three groups based on the type of neuraxial block listed in the block document of the patient's medical record:

Group 1 - Dural puncture epidural Group 2 - Epidural Group 3 - Combined spinal-epidural

Failure of epidural catheter conversion to surgical anesthesia at cesarean delivery will be defined by requirement of a second anesthetic at the time of surgery, including spinal or repeat epidural techniques or general anesthesia at the time of cesarean delivery

Data Collection: All data will be collected retrospectively from the electronic medical record.

  1. Type of neuraxial block
  2. Size of needle used for DPE or CSE: 25 g or 27 g
  3. Duration of time from epidural placement until CD (Time of epidural placement; time of delivery)
  4. Number of epidural top-ups
  5. Type and amount of medication used for conversion to surgical anesthesia
  6. Urgency of cesarean delivery
  7. Airway documentation indicative of general anesthesia (if applicable)
  8. Length (time) of surgical procedure

Other data collected from patient electronic records will include:

  1. Maternal demographics: Parity, number of prior cesarean deliveries, weight, height, BMI
  2. Fetal characteristics (birthweight, Apgar scores)

  3. Indication for cesarean delivery

    1. Fetal distress (NRFHT, fetal intolerance of labor)
    2. Failure of labor (Failure to dilate, failure to descend)
    3. Failed operative vaginal delivery
    4. Maternal comorbidity
    5. Emergency (cord prolapse, abruption, uterine rupture)
  4. Anesthesiologist (Fellowship trained: Y/N) at time of cesarean delivery

Study Type

Observational

Enrollment (Estimated)

1500

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

  • Canada
    • British Columbia
      • Vancouver, British Columbia, Canada
        • BC Women's Hospital
  • United States
    • Minnesota
      • Rochester, Minnesota, United States, 55902
        • Mayo Clinic

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

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Sampling Method

Non-Probability Sample

Study Population

Parturients that undergo intrapartum cesarean delivery with an epidural already in situ.

Description

Inclusion Criteria:

  1. Women with neuraxial labor analgesia (CSE, DPE, or Epidural) who have an intrapartum cesarean delivery
  2. Singleton gestation

Exclusion Criteria:

  1. No local anesthetic given in epidural for cesarean delivery (in emergency situation)
  2. Inadvertent dural puncture

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

  • Observational Models: Cohort
  • Time Perspectives: Retrospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Dural puncture epidural (DPE)
Subjects that received neuraxial labor analgesia of dural puncture epidural for intrapartum cesarean delivery
Procedure: Dural Puncture Epidural (DPE) technique
Epidural catheters placed via DPE technique
Combined spinal epidural (CSE)
Subjects that received neuraxial labor analgesia of combined spinal epidural for intrapartum cesarean delivery
Procedure: Combined Spinal-Epidural (CSE) technique
Epidural catheters placed via CSE technique
Traditional Epidural
Subjects that received neuraxial labor analgesia of epidural for intrapartum cesarean delivery
Procedure: Epidural
Traditional epidural catheter placement

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Conversion to surgical anesthesia
Time Frame: Baseline
Number of subject to have success of conversion to surgical anesthesia for intrapartum cesarean delivery
Baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Mayo Clinic

Collaborators

University of British Columbia

Investigators

  • Principal Investigator: Emily Sharpe, MD, Mayo Clinic

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.

Helpful Links

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)

February 1, 2017

Primary Completion (Estimated)

July 1, 2027

Study Completion (Estimated)

July 1, 2027

Study Registration Dates

First Submitted

August 22, 2022

First Submitted That Met QC Criteria

August 22, 2022

First Posted (Actual)

August 24, 2022

Study Record Updates

Last Update Posted (Actual)

September 2, 2026

Last Update Submitted That Met QC Criteria

August 31, 2026

Last Verified

August 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 20-004677

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

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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