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Prediction of Local Anaesthetic Dosing During Labour Epidural Analgesia (DIANA)

22 mai 2026 mis à jour par: ZANFINI BRUNO ANTONIO, Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Prediction of Local Anaesthetic Dosing During Labour Epidural Analgesia: a Machine-learning Approach. The DIANA (Dosing Intrapartum ANAesthetics) Study.

Epidural analgesia is the gold standard for controlling labour pain. However, labour pain happens during neuraxial analgesia, due to anaesthetic, obstetric, maternal factors.

The investigators hypothesized that relevant variables, able to predict the local anaesthetic (LA) requirement during labour, can be identified at admission and each parturient may therefore be accordingly classified in "low-requirement" and "high-requirement". In this way, a predictive score may be developed, and the analgesic regimen may be matched to the individual patient, thus ensuring a timely and appropriate treatment of patients likely to require higher doses of LA, while minimizing potentially side effects of excessive treatment in the low-dose group.

Aperçu de l'étude

Statut

Pas encore de recrutement

Les conditions

Intervention / Traitement

Type d'étude

Observationnel

Inscription (Estimé)

12500

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Coordonnées de l'étude

Lieux d'étude

  • Italie
    • RM
      • Rome, RM, Italie, 00168
        • Fondazione Policlinico Universitario A. Gemelli IRCCS

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

  • Adulte
  • Adulte plus âgé

Accepte les volontaires sains

Non

Méthode d'échantillonnage

Échantillon non probabiliste

Population étudiée

All parturients who delivered via vaginal route or intrapartum caesarean section and received neuraxial analgesia (epidural analgesia (EA) or combined spinal-epidural [CSE] analgesia or dural puncture epidural (DPE)) in Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, between January 1st, 2020 and March 01th, 2026 (including follow-up data), meeting the inclusion criteria.

La description

Inclusion Criteria:

  • Parturients receiving neuraxial analgesia for labour, as clinical practice

Exclusion Criteria:

  • Planned caesarean delivery

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

Cohortes et interventions

Groupe / Cohorte
Intervention / Traitement
All parturients between January 2020 and March 2026
All parturients who delivered via vaginal route or intrapartum caesarean section and received neuraxial analgesia (epidural analgesia (EA) or combined spinal-epidural [CSE] analgesia or dural puncture epidural (DPE)) in Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, between January 1st, 2020 and March 01th, 2026 (including follow-up data), meeting the inclusion criteria. Labour analgesia was maintained through manual top-up boluses or PIEB (Programmed Intermittent Epidural Bolus).
Autre: Machine-learning prediction model
A machine-learning prediction model will be developed to anticipate the parturient's requirement of LA at admission in the Labour Suite, according to demographic, obstetric and anaesthetic features ongoing before administration of the first epidural bolus.

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Machine-learning algorithm able to predict the LA consumption
Délai: From the epidural catheter placement to delivery.
To develop a machine-learning algorithm able to predict the mean hourly cumulative LA consumption administered via the epidural catheter from the catheter placement up to delivery, expressed as time-weighted LA consumption per hour (mg/h) in patients receiving top-up analgesia or the need for adjunctive rescue LA boluses in patients receiving PIEB (Programmed Intermittent Epidural Bolus) analgesia.
From the epidural catheter placement to delivery.

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Clinical score
Délai: At admission in the Labour Suite and before the epidural catheter is placed
To develop a clinical score, based on the machine learning algorithm, with the aim of predicting the patient's LA requirement at admission, thus categorizing parturients as "low requirement" or "high requirement".
At admission in the Labour Suite and before the epidural catheter is placed
Time-dependent AUC of LA manual boluses
Délai: From epidural catheter placement to delivery.
To compare (between low- and high-requirement parturients) the time-dependent AUC of LA boluses (in case of analgesia maintenance through top-up) and the time-dependent AUC of adjunctive rescue LA boluses (in case of analgesia maintenance through PIEB)
From epidural catheter placement to delivery.
Total LA consumption
Délai: From epidural catheter placement to delivery.
To compare between low- and high-requirement parturients the total LA consumption (mg), mean (+-SD)
From epidural catheter placement to delivery.
Ratio of time to first bolus demand to duration of labor
Délai: From epidural catheter placement to delivery.
To compare between low- and high-requirement parturients the ratio of time to first bolus demand to duration of labor (%), mean (+-SD), in case of analgesia maintenance through top-up.
From epidural catheter placement to delivery.
Total demand of LA boluses
Délai: From epidural catheter placement to delivery.
To compare between low- and high-requirement parturients the total demand of LA boluses, mean (+-SD), in case of analgesia maintenance through top-up.
From epidural catheter placement to delivery.
Total adjunctive rescue LA epidural boluses
Délai: From epidural catheter placement to delivery.
To compare between low- and high-requirement parturients the total adjunctive rescue LA epidural boluses, mean (+-SD), in case of analgesia maintenance through PIEB.
From epidural catheter placement to delivery.
Length of active phase
Délai: From start of the active phase to full cervical dilation, up to 24 hours.
To compare between low- and high-requirement parturients the length of active phase in minutes, mean (+-SD).
From start of the active phase to full cervical dilation, up to 24 hours.
Length of second stage
Délai: From full cervical dilation to delivery.
To compare between low- and high-requirement parturients the length of second stage in minutes, mean (+-SD).
From full cervical dilation to delivery.
Rate of postpartum haemorrhage
Délai: In the first hour after delivery.
To compare between low- and high-requirement parturients the rate of postpartum haemorrhage, expressed as percentage.
In the first hour after delivery.
Rate of perineal laceration
Délai: In the first hour after delivery.
To compare between low- and high-requirement parturients the rate of perineal laceration, expressed as percentage.
In the first hour after delivery.
Rate of episiotomy
Délai: At delivery.
To compare between low- and high-requirement parturients the rate of episiotomy, expressed as percentage.
At delivery.
Rate of shoulder dystocia
Délai: At delivery.
To compare between low- and high-requirement parturients the rate of shoulder dystocia, expressed as percentage.
At delivery.
Rate of intrapartum caesarean section
Délai: From admission to the Labour suite to delivery, up to 24 hours.
To compare between low- and high-requirement parturients the rate of intrapartum caesarean section, expressed as percentage.
From admission to the Labour suite to delivery, up to 24 hours.
Rate of catheter re-siting during labour
Délai: From the placement of the first epidural catheter to delivery, up to 24 hours.
To compare between low- and high-requirement parturients the rate of catheter re-siting during labour, expressed as percentage.
From the placement of the first epidural catheter to delivery, up to 24 hours.
Rate of neonatal admission in NICU
Délai: After delivery, up to 1 hour.
To compare between low- and high-requirement parturients the rate of neonatal admission in Neonatal Intensive Care Unit (NICU).
After delivery, up to 1 hour.
Mean Apgar Score at 1 minute
Délai: 1 minute after delivery.
To compare between low- and high-requirement parturients the neonatal Apgar score at 1 minute, expressed as mean +- DS. The Apgar score is a 10-point evaluation scoring system used to assess a newborn's health immediately after birth, based on 5 criteria: Appearance, Pulse, Grimace, Activity, and Respiration. Each category is assigned a score of 0, 1 or 2.
1 minute after delivery.
Mean Apgar Score at 5 minutes
Délai: 5 minutes after delivery.
To compare between low- and high-requirement parturients the neonatal Apgar score at 5 minutes, expressed as mean +- DS. The Apgar score is a 10-point evaluation scoring system used to assess a newborn's health immediately after birth, based on 5 criteria: Appearance, Pulse, Grimace, Activity, and Respiration. Each category is assigned a score of 0, 1 or 2.
5 minutes after delivery.
Mean Umbilical Cord Arterial pH
Délai: At delivery.
To compare between low- and high-requirement parturients the umbilical cord arterial pH, expressed as mean +- DS. Reference ranges of cord arterial pH is 7.2 - 7.4.
At delivery.
Mean Umbilical Cord Venous pH
Délai: At delivery.
To compare between low- and high-requirement parturients the umbilical cord venous pH, expressed as mean +- DS. Reference ranges of cord venous pH is 7.25 - 7.45.
At delivery.
Mean Umbilical Cord Arterial base excess
Délai: At delivery.
To compare between low- and high-requirement parturients the umbilical cord arterial base excess, expressed as mean +- DS. Reference ranges of cord arterial base excess is -9 to +2.
At delivery.
Mean Umbilical Cord Venous base excess
Délai: At delivery.
To compare between low- and high-requirement parturients the umbilical cord venous base excess, expressed as mean +- DS. Reference ranges of cord venous base excess is -10 to +0.
At delivery.
The rate of maternal hypertensive disorders.
Délai: Throughout pregnancy, up to the first postpartum day.
To compare between low- and high-requirement parturients the rate of maternal hypertensive disorders.
Throughout pregnancy, up to the first postpartum day.
The rate of gestational diabetes.
Délai: Throughout pregnancy, up to delivery.
To compare between low- and high-requirement parturients the rate of gestational diabetes.
Throughout pregnancy, up to delivery.

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Estimé)

13 juin 2026

Achèvement primaire (Estimé)

30 septembre 2026

Achèvement de l'étude (Estimé)

31 octobre 2026

Dates d'inscription aux études

Première soumission

8 mai 2026

Première soumission répondant aux critères de contrôle qualité

22 mai 2026

Première publication (Réel)

29 mai 2026

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

29 mai 2026

Dernière mise à jour soumise répondant aux critères de contrôle qualité

22 mai 2026

Dernière vérification

1 mai 2026

Plus d'information

Termes liés à cette étude

Mots clés

Autres numéros d'identification d'étude

  • 27389

Plan pour les données individuelles des participants (IPD)

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INDÉCIS

Informations sur les médicaments et les dispositifs, documents d'étude

Étudie un produit pharmaceutique réglementé par la FDA américaine

Non

Étudie un produit d'appareil réglementé par la FDA américaine

Non

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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