Trial of Onset of Epidural Pain Relief With Low Dose Bupivacaine and Different Doses of Fentanyl in Laboring Women
- Conditions
- Anesthetic, Sedative or Analgesic Complications in Labor or Delivery
- Interventions
- Registration Number
- NCT02004899
- Lead Sponsor
- Lawson Health Research Institute
- Brief Summary
Epidural analgesia is the most effective form of labor pain relief. Low doses of local anesthetic (freezing solutions) in combination with opioids (narcotics) are commonly used as epidural solutions to provide pain relief. Low dose local anesthetic solutions with opioids for labor have been shown to decrease motor block (leg weakness or temporary paralysis), without affecting labor pain relief. However, onset of pain relief can be delayed with these low dose solutions. The standard epidural solution used at Victoria Hospital is a low dose of local anesthetic called bupivacaine mixed with fentanyl, an opioid, for labor epidural pain relief.
There is some evidence that the addition of more fentanyl to the epidural bolus dose of bupivacaine at the start of labor epidural analgesia can speed onset of pain relief. Both medications are safe for you and your baby.
This study will investigate whether the addition of different doses of fentanyl (20 mcg, 50 mcg and 100 mcg) to the epidural bolus dose speeds onset of pain relief.
The study hypothesis is that the onset of epidural labor analgesia will be shortest with the larger fentanyl epidural bolus.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 105
- American Society of Anesthesiologists (ASA) physical status 1 or 2
- Pregnant women in early labor (cervical dilation <5cm)
- Singleton fetuses
- Gestational age more than 36 weeks
- Normal fetal heart rate tracing
- Severe pre-ecclampsia
- Antepartum hemorrhage
- ASA >3
- Chronic pain
- Substance abuse
- Language barrier between patient and investigator
- Contraindications to epidural analgesia
- Allergies to local anesthetics or fentanyl
- Morbid obesity
- Previous administration of opioid analgesia
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description F20 Fentanyl Patients randomized to this arm of the study receive 20 mcg fentanyl and 8 mg bupivacaine as their epidural loading dose F50 Fentanyl Patients randomized to this arm of the study receive 50 mcg fentanyl with 8 mg bupivacaine as their epidural loading dose F100 Fentanyl Patients randomized to this arm of the study receive 100 mcg fentanyl and 8 mg bupivacaine as their epidural loading dose
- Primary Outcome Measures
Name Time Method The time, in minutes, since completion of epidural bolus to the first painless contraction Time since epidural bolus dose administration (At 1 and 5 minutes ) A painless contraction = verbal Numeric Pain Rating Scale less than or equal to 3/10
- Secondary Outcome Measures
Name Time Method Time, in minutes, from epidural bolus dose to use of patient controlled epidural demand dose Estimated time frame 1 hour time after epidural loading dose at which patient uses Patient Controlled Epidural Analgesia administered bolus
Breastfeeding 24 hours after delivery Has breastfeeding been established at 24 hours post-delivery?
Sensory block height to ice 30 minutes after epidural bolus dose Pruritis 30 minutes after epidural bolus dose Pruritus will be measured using a 4-point scale, where 0 is none, 1 is mild, 2 is moderate, and 3 is severe.
Nausea 30 minutes after epidural bolus dose Nausea will be measured using a 4-point scale, where 0 is none, 1 is mild, 2 is moderate, and 3 is severe.
Maternal sedation 30 minutes after epidural bolus dose Maternal sedation will be measured using a 5-point scale where 0 is wide awake, 1 is mildly drowsy, 2 is very drowsy, 3 is asleep but rousable, and 4 is somnolent.
Hypotension 30 minutes after epidural bolus dose Hypotension is defined as a decrease in systolic blood pressure by 30% or more, or less than 90 mmHg. It is treated with intravenous ephedrine.
Motor block 30 minutes after epidural bolus dose Motor block will be assessed using a modified Bromage score (0 = ability to move hips, ankles, and knees, 1 = inability to raise extended leg, 2 = inability to flex knee, and 3 = inability to flex ankle, foot or knee).
Patient satisfaction of analgesia 30 minutes from epidural bolus dose Patient satisfaction of analgesia will be measured using a 5-point scale where 0 is completely dissatisfied, 1 is somewhat dissatisfied, 2 is neutral, 3 is somewhat satisfied, and 4 is completely satisfied.
Incidence of failed analgesia 30 minutes after epidural bolus dose Patients who have a verbal Numeric Rating Scale score greater than 3/10 after 30 minutes of epidural bolus dose will be deemed a failure.
Incidence of fetal bradycardia Estimated time frame 24 hours Neonatal Apgar scores At 1 and 5 minutes post-delivery Time, in minutes, from completion of epidural test dose to delivery Estimated time frame 24 hours Type of delivery Estimated time frame 24 hours Fetal birth weight Estimated time frame 24 hours
Trial Locations
- Locations (1)
Victoria Hospital
🇨🇦London, Ontario, Canada