There has been very little investigation into the management of pain from 2nd trimester termination of pregnancy or unexpected fetal loss. The standard of practice in North America is usually intravenous patient controlled analgesia (IV PCA), using a narcotic wuch as fentanyl. The goal of this study is to compare the quality of recovery after termination of pregnancy using fentanyl IV PCA or patient controlled epidural analgesia (PCEA), a standard of care for live births. The study will be conducted as a randomized controlled trial.
Epidural analgesia is known to provide superior analgesia for labour with minimal maternal and fetal side effects. This mode of analgesia is not usually offered to patients who require termination of their pregnancies or who suffer unexpected fetal losses, although they go through labour and delivery with likely more difficult psychological circumstances. We plan to compare patient controlled epidural analgesia (PCEA) with intravenous patient controlled analgesia (IV PCA), for 2nd trimester terminations of pregnancy. We hypothesize that PCEA provides better quality of recovery than IV PCA. The previously validated Quality of Recovery - 40 questionnaire will be used to measure a patient's quality of recovery. The results of this study will determine the optimal method of pain relief for late termination of pregnancy or fetal loss.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
42
10mL of 0.125% of bupivacaine plus 50 mcg fentanyl, injected through an epidural catheter.
fentanyl IV PCA with boluses 25-50 mcg, 3-6 minute lockout.
Mount Sinai Hospital
Toronto, Ontario, Canada
Quality of Recovery - 40 score on discharge
The primary outcome of this study will be the difference between IV PCA and PCEA groups in aggregate score of Quality of Recovery - 40 on discharge from hospital.
Time frame: up to 5 days
Duration of procedure
Duration of procedure from induction to abortion in hours
Time frame: 24 hours
Pain score
Visual analog pain score every 30 minutes during procedure
Time frame: 24 hours
Narcotic-related complications
Incidence of: nausea/vomiting, pruritis, sedation, respiratory depression.
Time frame: 24 hours
Epidural-related complications
Incidence of: hypotension, dural puncture, local anesthetic toxicity, neurological complications.
Time frame: 24 hours
Surgical intervention
Incidence of surgical intervention and any anesthetic required for intervention.
Time frame: 24 hours
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.