The purpose of this study to compare the use of spinal-epidural versus traditional labor epidural on maternal and fetal effects. The hope is to determine the safest and most effective epidural method of relieving pain during labor.
Combined spinal-epidural anesthesia (CSE) was developed to allow excellent pain control for the pregnant woman who arrives in advanced labor and does not have much time for the anesthetic to have its effect. This has been extended recently to women in all stages of labor because of its rapid and excellent control of pain. Recent case series comparing CSE with traditional epidural have shown a slight difference in the rate of hypotension and fetal bradycardia, with the CSE technique having a higher rate of both of these side effects. This study will compare the two techniques in a prospective, randomized method. The aim is to compare the maternal and fetal effects of two neuraxial block techniques for pain control during labor, to document blood pressure changes in upper and lower extremities pre- and post- block placement, and to document side effects (e.g. pruritus) and patient satisfaction with both techniques.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
127
Bupivacaine 0.25% x 1 cc + Fentanyl 20 mcg, followed by infusion of Bupivacaine 0.0625% with Fentanyl 2 mcg/mL at 12 cc/hr
Bupivacaine 0.0625% with Fentanyl 2 mcg/mL x 15 cc, followed by infusion of Bupivacaine 0.0625% with Fentanyl 2 mcg/mL at 12 cc/hr
New York-Presbyterian Hospital; Weill Medical College of Cornell
New York, New York, United States
Adverse fetal effects: fetal bradycardia and abnormal fetal heart rate patterns
Time frame: during the 60 minutes after placement of analgesia
Average change in systolic blood pressure
Time frame: during the 60 minutes after placement of analgesia
Average change in mean blood pressure
Time frame: during the 60 minutes after placement of analgesia
Blood pressure differences between the upper and lower extremities
Time frame: during the 60 minutes after placement of analgesia
Efficacy of analgesia as rated by the visual analog pain scale
Time frame: during the 60 minutes after analgesic placement
Pruritus
Time frame: through the first day following placement of analgesia
Incidence of hypotension
Time frame: during the 60 minutes after placement of analgesia
Patient satisfaction
Time frame: first day following placement of analgesia
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