Conversion of Labor Analgesia for Intrapartum Cesarean Delivery: DPE v CSE v Epidural
Study Details
Study Description
Brief Summary
As the dural puncture epidural (DPE) is increasing in popularity for labor analgesia, it is important to understand how it impacts outcomes in parturients. Prior studies have found epidural catheters placed via the combined-spinal epidural technique have greater success at surgical conversion for cesarean delivery than catheters placed via traditional techniques. We aim to determine if epidural catheters placed by a DPE technique will also have an increased successful conversion for surgical anesthesia by conducting a retrospective review of all CD during the study period. If an association is found, this could be another benefit of DPE for labor analgesia.
Condition or Disease | Intervention/Treatment | Phase |
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Detailed Description
Electronic medical records will be searched for all intrapartum cesarean deliveries performed from February 1, 2017 through May 30, 2021 (Mayo Clinic) and from January 1, 2022 to December 31, 2022 (BC Women's Hospital).
From this list, patients that had cesarean delivery with an epidural catheter will be identified and split into three groups based on the type of neuraxial block listed in the block document of the patient's medical record:
Group 1 - Dural puncture epidural Group 2 - Epidural Group 3 - Combined spinal-epidural
Failure of epidural catheter conversion to surgical anesthesia at cesarean delivery will be defined by requirement of a second anesthetic at the time of surgery, including spinal or repeat epidural techniques or general anesthesia at the time of cesarean delivery
Data Collection: All data will be collected retrospectively from the electronic medical record.
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Type of neuraxial block
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Size of needle used for DPE or CSE: 25 g or 27 g
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Duration of time from epidural placement until CD (Time of epidural placement; time of delivery)
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Number of epidural top-ups
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Type and amount of medication used for conversion to surgical anesthesia
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Urgency of cesarean delivery
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Airway documentation indicative of general anesthesia (if applicable)
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Length (time) of surgical procedure
Other data collected from patient electronic records will include:
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Maternal demographics: Parity, number of prior cesarean deliveries, weight, height, BMI
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Fetal characteristics (birthweight, Apgar scores)
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Indication for cesarean delivery
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Fetal distress (NRFHT, fetal intolerance of labor)
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Failure of labor (Failure to dilate, failure to descend)
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Failed operative vaginal delivery
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Maternal comorbidity
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Emergency (cord prolapse, abruption, uterine rupture)
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Anesthesiologist (Fellowship trained: Y/N) at time of cesarean delivery
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Dural puncture epidural (DPE) Subjects that received neuraxial labor analgesia of dural puncture epidural for intrapartum cesarean delivery |
Procedure: Dural Puncture Epidural (DPE) technique
Epidural catheters placed via DPE technique
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Combined spinal epidural (CSE) Subjects that received neuraxial labor analgesia of combined spinal epidural for intrapartum cesarean delivery |
Procedure: Combined Spinal-Epidural (CSE) technique
Epidural catheters placed via CSE technique
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Traditional Epidural Subjects that received neuraxial labor analgesia of epidural for intrapartum cesarean delivery |
Procedure: Epidural
Traditional epidural catheter placement
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Outcome Measures
Primary Outcome Measures
- Conversion to surgical anesthesia [Baseline]
Number of subject to have success of conversion to surgical anesthesia for intrapartum cesarean delivery
Eligibility Criteria
Criteria
Inclusion Criteria:
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Women with neuraxial labor analgesia (CSE, DPE, or Epidural) who have an intrapartum cesarean delivery
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Singleton gestation
Exclusion Criteria:
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No local anesthetic given in epidural for cesarean delivery (in emergency situation)
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Inadvertent dural puncture
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Mayo Clinic | Rochester | Minnesota | United States | 55902 |
2 | BC Women's Hospital | Vancouver | British Columbia | Canada |
Sponsors and Collaborators
- Mayo Clinic
- University of British Columbia
Investigators
- Principal Investigator: Emily Sharpe, MD, Mayo Clinic
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
None provided.- 20-004677