Epidural Analgesia Clinical Trial
Official title:
A Comparative Study of Success Rate, Efficacy, Safety Between Electrical Stimulation-guided Epidural Catheter Placement and the Loss of Resistance Conventional Method for Vaginal Delivery
Forty pregnant women (36 to 41 weeks gestation) will randomly allocate to two groups. Groups will be defined based on the method used to identify the epidural space for epidural anesthesia: the loss of resistance group (n=20) and the epidural electrical stimulation group (n=20). Pain will be assessed using a numerical visual analog scale and maternal satisfaction by a post-partum interview. The success rate of epidural analgesia, maternal satisfaction, and neonatal Apgar scores will be compared between groups.
Investigators will place epidural catheter in the epidural space using loss of resistance
technique, and will confirm correct placement of the epidural catheter using electrical
stimulation.
Epidural catheter placement, electrical stimulation, and confirmation of response is
followed:
Patients will be placed in the left lateral decubitus position. The site will be aseptically
prepared and 1% lidocaine will be infiltrated to the skin. An 18-gauge Tuohy needle will be
inserted midline of L4/5 interspinous space.
For the Loss of resistance (LOR) group, after identification of the epidural space, the
Tuohy needle will be stopped, and a 20-gauge epidural catheter will be advanced through the
Tuohy needle.
The same process will be followed for the Epidural electrical stimulation (EES) group. In
addition, the epidural space will be confirmed by epidural electrical stimulation using a
20-gauge epidural catheter (RegionalStimTm, Sewoon Medical Co., Ltd, Seoul, Korea, 800 mm)
with a conductive guidewire (conductive guidewire, Nitinol, 1100 mm).
After confirming there is no reverse flow of cerebrospinal fluid or blood with aspiration, 3
mL of 1% lidocaine, with 15 mcg of epinephrine (1:200000), will be injected through the
epidural catheter as test dose. If there is no response to the test dose, patients will be
moved to the delivery room. To control labor pain, a one-time injection containing 50 mcg of
fentanyl, 3 mL of 0.75% ropivacaine, and 6 mL of normal saline (total volume 10 mL) will be
administered. A continuous infusion of 3 to 10 mL/hour depending on the patient's pain will
be used of 75 mcg of fentanyl, 8.5 mL of 0.75% ropivacaine, and 40 mL of normal saline
(total volume 50 mL).
Blood pressure (BP), heart rate (HR), oxygen saturation (SpO2), and neurologic assessment
findings will be monitored up to 72 hours after labor.
Pain relief in labor is assessed by a change in the visual analogue scale (VAS) score. A 10
point VAS, where 0 is no pain and 10 is unbearable pain, is used to assess pain during
labor. The scale is assessed before epidural anesthesia and after epidural anesthesia.
Differences in the VAS response we used to assess the efficacy of the epidural anesthesia in
decreasing labor pain. Comparison of the change in VAS between groups is used to compare
pain control of the two methods. The success of epidural analgesia is defined by sensory
block, without motor block, and a decrease in pain score after adequate dosing of epidural
medication. Failure of epidural analgesia is defined by a lack of sensory block and a less
that 2 point difference on the VAS after adequate dosing of epidural medications.
Patient satisfaction will be evaluated by a postpartum interview. Satisfaction is graded
between a score of 1-5, where 1 represent very unsatisfied and 5 represent very satisfied.
Patients will indicate a score of 1 to 5.
One- and 5-minute Apgar scores will be compared to assess the effect of epidural electrical
stimulation on the neonate. Additional time required for epidural electrical stimulation
will be determined by the difference (in seconds) from LOR to identification of the epidural
space through electrical stimulation.
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