Anon Invasive Confirmatory Sign for Correct Epidural Catheter Placement During Normal Vaginal Delivery
Trial Snapshot
- Phase
- Not Applicable
- Sponsor
- Ain Shams University
- Enrollment
- 100
- Primary Endpoint
- appearance of the dew sign
Study Overview
Brief Summary
Epidural anesthesia for pain control during normal vaginal delivery is a blind maneuver and so we need a confirmatory sign for being in the correct epidural space.
Loss of resistance sign using air may guide us wrongly as it may occur if we entered into the paravertebral muscles or cavities in the interspinal ligaments.
So, additional confirmatory sign beside loss of resistance sign by air is strongly needed.
We noticed that after occurence of loss of resistance sign by air and insertion of the epidural catheter a dew was formed on the internal sides of the epidural catheter after aspiration to be sure that there are no blood or cerebrospinal fluid in the catheter.
This dew formation (Ramy sign) is characteristic for air in the epidural space when transferred from the warm epidural space (temperature about 38-39 celsius degree) to the colder aspect of the catheter outside the patient which nearly has the same operating room temperature (22 celsius degree).
This sign may be associated with correct placement and good function of the epidural catheter.
Detailed Description
parturient for normal vaginal delivery are examined for correct epidural catheter placement by loss of resistance technique by air, observation of the dew sign and epidurogram.
Visual analogue score is used to test pain. blood pressure and heart rate after epidural injection will be monitored
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to 45 Years (Adult)
- Sex
- Female
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Parturient for normal vaginal delivery
- •American society of anesthesiologists 2
Exclusion Criteria
- •patients refusal
- •back infection
- •anticoagulant non stopped
- •platelets count less than 100000
- •international normalization ratio more than 1.4
- •severe cardiac or respiratory diseases
- •haemodynamics unstable patients
Arms & Interventions
epidural anesthesia
Intervention: epidural catheter placement (Procedure)
Outcomes
Primary Outcomes
appearance of the dew sign
Time Frame: immediately during aspiration of the epidural catheter
dew formation inside the outer portion of the epidural catheter near the patient
Secondary Outcomes
- mean blood pressure(30 minutes after epidural injection by 10 milliliter bupivacaine 0.25%)
- heart rate(30 minutes after epidural injection by 10 milliliter bupivacaine 0.25%)
- epidurogram(immediately after epidural catheter insertion)
- visual analogue score(20 minutes after epidural injection by 10 milliliter bupivacaine 0.25%)
- mean blood pressure(20 minutes after epidural injection by 10 milliliter bupivacaine 0.25%)
- heart rate(20 minutes after epidural injection by 10 milliliter bupivacaine 0.25%)
Investigators
RAMY AHMED
Assistant Professor of Anesthesia
Ain Shams University