A Non Invasive Confirmatory Sign for Correct Epidural Catheter Placement During Normal Vaginal Delivery
- Conditions
- Normal Delivery Pain
- Interventions
- Procedure: epidural catheter placement
- Registration Number
- NCT06371456
- Lead Sponsor
- Ain Shams University
- 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
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- Female
- Target Recruitment
- 100
- Parturient for normal vaginal delivery
- American society of anesthesiologists 2
- 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
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description epidural anesthesia epidural catheter placement -
- Primary Outcome Measures
Name Time Method appearance of the dew sign immediately during aspiration of the epidural catheter dew formation inside the outer portion of the epidural catheter near the patient
- Secondary Outcome Measures
Name Time Method mean blood pressure 30 minutes after epidural injection by 10 milliliter bupivacaine 0.25% by non invasive monitor
heart rate 30 minutes after epidural injection by 10 milliliter bupivacaine 0.25% by non invasive monitor
epidurogram immediately after epidural catheter insertion by using posteroanterior x-ray image after injection of radiopaque dye through the epidural catheter with appearance of distribution of the dye in the epidural space and may exit through the neuroforamina laterally
visual analogue score 20 minutes after epidural injection by 10 milliliter bupivacaine 0.25% making a handwritten mark on a 10 cm line that represents a continuum between "no pain" and "worst pain"