Cervical Capsaicin for Labor Induction and Pain Relief

Sponsor
Columbia University (Other)
Overall Status
Withdrawn
CT.gov ID
NCT00771511
Collaborator
(none)
0
2
8

Study Details

Study Description

Brief Summary

In the setting of fetal demise it is important to help the mother deliver the fetus expeditiously and with as little physical trauma as possible. This study hypothesizes that application of capsaicin to the uterine cervix will enhance cervical ripening and desensitize pain fibers such that delivery is less painful.

Condition or Disease Intervention/Treatment Phase
Phase 4

Detailed Description

Induction of labor is associated with increased risk of cesarean section and elevated pain when compared to labor of spontaneous onset. In the setting of intrauterine fetal demise (IUFD), it is desirable to induce labor in order to achieve a successful vaginal delivery for the health and well being of the mother, thereby avoiding operative fetal extraction.

The current protocol for midtrimester labor induction prior to 24 weeks gestational age includes intravaginal cytotec(misoprostol) 200 mcg every 6 hours for up to 24 hours, occasionally followed by oxytocin infusion. When an IUFD occurs at 24 or greater weeks gestational age, labor is induced with cytotec 25 or 50 mcg every 4 hours and/or oxytocin infusion. The investigators hypothesize that application of lidocaine to the uterine cervix followed by 0.1% capsaicin cream will facilitate cervical ripening and decrease the pain of labor induction when compared to use of a placebo cream. Capsaicin 8methylNvannilyl6nonenamide) activates TRPV1, a nonselective cation channel activated directly by heat, and low pH, and indirectly by a number of inflammatory factors, including nerve growth factor (NGF), bradykinin, lipids, and prostaglandins. Activation of TRPV1 by capsaicin results in an influx of Ca2 and Na ions, depolarization, exocytosis of neuropeptides and excitatory amino acids, and induces a burning sensation. This initial phase is followed by prolonged desensitiztion that is dose dependent. Once the TRPV1 receptor is desensitized, pain transmission through Ctype primary afferent receptors is reduced. The pain relief from capsaicin is due to desensitization of the TRPV1 receptor. The enhancement of cervical ripening is due to activation of primary afferent Cfibers, release of neuropeptides substance P, neurokinin A, calcitonin generelated peptide, secretoneurin and nitric oxide to help orchestrate a series of local inflammatory responses including vasodilation, vascular permeability with tissue edema and protein extravasation, and migration of inflammatory immune cells. In a study of pregnant rats, vaginal lidocaine gel was applied followed by capsaicin sham cream. A blinded observer monitored behavior via video over the next 72 hours. All animals treated with capsaicin delivered on day 22 with minimal pain behaviors while 90% of sham treated animals delivered as expected on day 23 with normal pain related behavior. All pups were delivered live and rearing and suckling behavior was normal.

Study Design

Study Type:
Interventional
Actual Enrollment :
0 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose:
Treatment
Official Title:
Cervical Capsaicin for Labor Induction and Pain Relief
Anticipated Study Start Date :
Oct 1, 2010
Anticipated Primary Completion Date :
Jun 1, 2011
Anticipated Study Completion Date :
Jun 1, 2011

Arms and Interventions

Arm Intervention/Treatment
Experimental: 1

Capsaicin cream applied to cervix after lidocaine gel

Drug: capsaicin
capsaicin cream 0.1% 10 ml applied to cervix

Placebo Comparator: 2

only lidocaine applied to the cervix

Drug: Placebo
Only lidocaine gel will be appled to the cervix

Outcome Measures

Primary Outcome Measures

  1. Pain report during labor [48 hours after labor induction]

Secondary Outcome Measures

  1. Bishop's score [48 hours]

Eligibility Criteria

Criteria

Ages Eligible for Study:
18 Years to 50 Years
Sexes Eligible for Study:
Female
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  • IUFD after 20 weeks gestation
Exclusion Criteria:
  • Chorioamnionitis

  • Chronic pain syndrome

  • Current pain meds during pregnancy

Contacts and Locations

Locations

No locations specified.

Sponsors and Collaborators

  • Columbia University

Investigators

  • Principal Investigator: Pamela Flood, MD, Columbia University

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.
Responsible Party:
Pamela Flood, Professor of Anesthesiology, Columbia University
ClinicalTrials.gov Identifier:
NCT00771511
Other Study ID Numbers:
  • AAAD5899
First Posted:
Oct 13, 2008
Last Update Posted:
Aug 9, 2021
Last Verified:
Aug 1, 2021
Studies a U.S. FDA-regulated Drug Product:
Yes
Studies a U.S. FDA-regulated Device Product:
No
Additional relevant MeSH terms:

Study Results

No Results Posted as of Aug 9, 2021