Does Body Mass Index Impact the Outcome of Dural Puncture Epidural in Parturients Undergoing Normal Vaginal Delivery

Ain Shams University64 enrolled

Overview

Recently, the dural puncture epidural (DPE) technique has emerged as a novel method of labor analgesia. The DPE technique is a modification of the combined spinal epidural (CSE) technique, where a dural perforation is created from a spinal needle but intrathecal medication administration is withheld. The DPE technique has been shown to improve caudal spread of analgesia compared with epidural technique without the side effects observed with the CSE technique.

Investigators designed this prospective interventional study to determine if morbid obesity would influence DPE technique regarding labor analgesia onset and block characteristics.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

TRIPLE

Enrollment

Conditions

Morbid Obesity

Interventions

Dural puncture epiduralOTHER

Parturients, between 18 and 45 years of age, with cervical dilation less than 5 cm were consented to receive a DPE technique, with a single dural puncture with a 26-gauge spinal needle. After successful placement of the epidural catheter and puncturing the dura; 20 mL of bupivacaine 0.25% was administered through the epidural catheter and a patient-controlled epidural infusion of bupivacaine was initiated.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 45 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. 18 - 45 years old, 2. Physical status American society of anesthesiology (ASA) II, 3. Singleton, 4. Vertex fetuses at 37-41 weeks' gestation, 5. Nulliparous and multiparous women, 6. Immediately before epidural placement, subjects marked a VNRS score during an active contraction and parturients with VNRS ≥ 50 were included 7. Cervical dilatation \< 5 cm Exclusion Criteria: 1. Contraindications to regional anesthesia 2. Refuse to participate 3. No pain 4. Severe systemic disease (kidney, liver, pulmonary, endocrine, cardiac) 5. Conditions associated with an increased risk of a cesarean delivery (i.e., history of uterine anomaly or surgery) and vaginal birth after cesarean delivery

Locations (1)

Ain Shams University

Cairo, Egypt

Outcomes

Primary Outcomes

Incidence of adequate analgesia

The primary outcome of this study is the incidence of patients having adequate analgesia (VNRS \<30) at 5 minutes of epidural activation

Time frame: 5 minutes

Secondary Outcomes

Verbal numerical pain score scale ( 0 being no pain and 100 being the worst pain )

Verbal numerical pain score (VNRS) (pain) was recorded before epidural (0 min baseline), at 5 min, 10 min, 15 min and then every 15 min till 1 hour and then every 30 min till delivery.

Time frame: 6 hours

Sensory level of DPE by pricking by blunt head of a pin

* Was recorded before epidural (0 min-baseline), at 5 min, 10 min, 15 min and then every 15 min till 1 hour and then every 30 min till delivery. * Sensory level of DPE was assessed by loss of sensation to prick by blunt head of a pin.

Time frame: 6 hours

Motor block Bromage score (1 being complete motor block and 6 being no motor block)

* Motor strength was assessed with a modified Bromage score * Was recorded before epidural (0 min baseline), at 5 min, 10 min, 15 min and then every 15 min till 1 hour and then every 30 min till delivery.

Time frame: 6 hours

Data from ClinicalTrials.gov

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