Ultrasound-Guided Landmark and Epidural Site Pain
Condition: Back Pain; Epidural Analgesia, Obstetric
MeSH terms: Back Pain
Study type: Interventional

Summary: 
      Historically, women who have chronic back pain after pregnancy have attributed the cause to
      the epidural procedure. While many studies have shown no greater incidence of generalized
      post-partum back pain in those who received an epidural, no studies have measured localized
      pressure sensitivity at the epidural insertion site. Short-term pressure sensitivity might
      limit patient's mobility and activities in the post-partum period. Understanding the factors
      that increase insertion site pressure sensitivity will allow the investigators to modify
      epidural placement technique in order to minimize this effect.
    

Detailed description: 
      Few studies have examined how epidural placement changes localized sensation at the epidural
      insertion site. This study will be the first study to quantitatively measure sensation at the
      epidural insertion site. The investigator will assess localized pressure sensitivity with an
      algometer. An algometer is a hand-held device commonly used by neurologist to detect sensory
      deficits and measures the pressure sensitivity threshold in a 1-cm diameter circular area.
      Ultrasound (US) pre-procedural examination provides more accurate landmarks for the placement
      of epidural catheters. The investigator will determine if an US examination prior to epidural
      placement reduces localized pressure sensitivity. The investigator will also determine if
      there are correlations between the participants characteristics and/or comorbidities and
      increased pressure sensitivity at the insertion site.
    

Intervention name(s): US-epidural SVD; US sham- epidural SVD; Spontaneous vaginal delivery without an Epidural
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): participants who received US examination prior to epidural placement. The purpose of this group is to determine if US derived landmarks reduce pressure sensitivity.; participants who received US examination process but with the monitor turned off. The purpose of this group is to determine if the standard of care epidural placement technique will increase pressure sensitivity at the insertion site. The purpose of this group will also be to reduce the placebo effect from the US exam and to maintain blinding of the patient to their group status (US epidural or US sham epidural).; Spontaneous vaginal delivery without an Epidural The purpose of the control group is to serve as a baseline (or a measure of normal). The control participant's measurement will be compared to those that did receive treatments (either epidural alone or ultrasound and epidural). This information will tell the investigator how many women have back pain after spontaneous vaginal delivery. Participant must meet the inclusion requirements and not meet any of the exclusion requirements
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Acute Pain; ultrasonography