Conversion of Labor Analgesia for Intrapartum Cesarean Delivery: DPE v CSE v Epidural
Ориентир для пациента и семьи
Простыми словами
Автоматическая сводка по структурированным данным реестра. Она помогает сориентироваться, но не заменяет официальный протокол или оценку врача.
- Что изучают
- В протоколе указаны: Epidural, Dural Puncture Epidural (DPE) technique, Combined Spinal-Epidural (CSE) technique.
- Кому может быть актуально
- Состояния в реестре: Anesthesia, Analgesia. Базовые параметры: Без ограничений · Женщины.
- Что важно проверить
- Возраст, диагноз и пол — только базовые ориентиры. Предыдущее лечение, анализы и другие обязательные условия указаны ниже в критериях участия.
- Где проводится
- США, Канада
- Следующий шаг
- Сохраните исследование, покажите его лечащему врачу и уточните актуальный статус у исследовательского центра. Расходы, документы и поездка →
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Официальное название
Conversion of Labor Analgesia for Intrapartum Cesarean Delivery: Dural Puncture Epidural vs Combined Spinal Epidural vs Epidural
Обзор
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. The investigators 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.
Подробное описание
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.
1. Type of neuraxial block 2. Size of needle used for DPE or CSE: 25 g or 27 g 3. Duration of time from epidural placement until CD (Time of epidural placement; time of delivery) 4. Number of epidural top-ups 5. Type and amount of medication used for conversion to surgical anesthesia 6. Urgency of cesarean delivery 7. Airway documentation indicative of general anesthesia (if applicable) 8. Length (time) of surgical procedure
Other data collected from patient electronic records will include:
1. Maternal demographics: Parity, number of prior cesarean deliveries, weight, height, BMI 2. Fetal characteristics (birthweight, Apgar scores) 3. Indication for cesarean delivery
1. Fetal distress (NRFHT, fetal intolerance of labor) 2. Failure of labor (Failure to dilate, failure to descend) 3. Failed operative vaginal delivery 4. Maternal comorbidity 5. Emergency (cord prolapse, abruption, uterine rupture) 4. Anesthesiologist (Fellowship trained: Y/N) at time of cesarean delivery
Вмешательства
- Процедура Epidural
Traditional epidural catheter placement - Процедура Dural Puncture Epidural (DPE) technique
Epidural catheters placed via DPE technique - Процедура Combined Spinal-Epidural (CSE) technique
Epidural catheters placed via CSE technique
Первичные конечные точки
- Conversion to surgical anesthesia [Срок оценки: Baseline]
Критерии участия
Критерии включения
- Women with neuraxial labor analgesia (CSE, DPE, or Epidural) who have an intrapartum cesarean delivery
- Singleton gestation
Критерии исключения
- No local anesthetic given in epidural for cesarean delivery (in emergency situation)
- Inadvertent dural puncture
Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.
Здоровые добровольцы: Да
Дизайн исследования
- Модель наблюдения
- Когортное
Центры проведения
США · 1 центр
- Mayo Clinic — Rochester
Канада · 1 центр
- BC Women's Hospital — Vancouver
Идентификаторы
NCT: NCT05514431 · 20-004677