Epidural Tap in Labor Analgesia FOR LABOR ANALGESIA

Study Overview
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Brief Summary
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The dural epidural tap method is performed by creating a dural perforation with a spinal needle placed through epidural needle, followed by placement of a catheter into the epidural space. No medications are administered through spinal needle. This prospective, randomized study includes 70 ASA II primigravid women with cervical dilatation between 4-6 cm and demanding epidural analgesia during spontaneous vaginal delivery.In the first group, 20 mL of 0.125% bupivacaine + 2 mcg/mL fentanyl solution and in the second group, 20 mL of 0.0625% bupivacaine + 2 mcg/mL fentanyl solution was administered as the first dose through the epidural catheter. Then, the visual analog scale (VAS) score was aimed to be below 4 in both groups.

Detailed Description
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This prospective, randomized study includes 70 ASA II primigravid women with cervical dilatation between 4-6 cm and demanding epidural analgesia during spontaneous vaginal delivery. Participants with pregnancy-related diseases (such as gestational hypertension, gestational diabetes, preeclampsia) and contraindications for neuraxial block (infection, coagulation disorder, severe hypovolemia, sepsis, neurological deficit, cardiac valve stenosis or hypertrophic obstructive cardiomyopathy) will be excluded from the study. Women with fetal malpresentation and fetal anomaly will also be excluded. Participants will randomly be divided into 2 equal groups. Immediately before epidural placement, subjects will be marked a VAS score during an active contraction. All subjects will have an intravenous catheter placed and be monitored with NST, noninvasive blood pressure and pulse oximetry. The epidural space will be identified by a loss of resistance technique to saline. CSF flow will be observed at L3-L4 or L4-L5 level by puncturing the dura with a 27 G needle before inserting the epidural catheter. A combined spinal epidural set with 18 G Tuohy needle will be used in both groups. In the first group, 20 mL of 0.125% bupivacaine + 2 mcg/mL fentanyl solution and in the second group, 20 mL of 0.0625% bupivacaine + 2 mcg/mL fentanyl solution will be administered as the first dose through the epidural catheter. Then, the visual analog scale (VAS) score will be aimed to be below 4 in both groups. Patients with a VAS score of 4 or higher 15 minutes after the first dose received, an additional 10 mL dose of the same solution will be given. An additional 10 mL dose also will be administered when the VAS score is 4 or higher until crowning. Before the epidural catheter placed; age, weight, height, blood pressure of the participants, gestational week, use of oxytocin during delivery, cervical dilatation amount before the procedure and fetal heart rate will be recorded. After each dose of administration, whether maternal hypotension, fetal bradycardia, pruritus, nausea-vomiting or motor block development will be monitored. The total amount of drug administered through the epidural catheter, the time between applications, and the number of bolus doses administered will also be recorded.

Official Title
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Effects of Different Local Anesthetic Concentrations With Epidural Tap Method for Labor Analgesia

Conditions
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Labor Pain

Intervention / Treatment
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* Drug: Dolantin
* Drug: Paracetamol


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA II primigravid women with cervical dilatation between 4-6 cm, demanding epidural analgesia during spontaneous vaginal delivery Exclusion Criteria: Participants with pregnancy-related diseases gestational hypertension gestational diabetes preeclampsia/ celmpsia contraindications for neuraxial block infection coagulation disorders severe hypovolemia sepsis neurological deficit cardiac valve stenosis or hypertrophic obstructive cardiomyopathy Women with fetal malpresentation and fetal anomaly

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Single Group Assignment
Interventional Model Description: 70 ASA II primigravid women with cervical dilatation between 4-6 cm and demanding epidural analgesia during spontaneous vaginal delivery
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: High concentration<br>Epidural analgesia with 20 mL of 0.125% bupivacaine + 2 mcg/mL fentanyl solution | Drug: Dolantin<br>* If VAS score is more than 4 even after additional dose, use dolantin 1 mg/kg<br>* Other names: Meperidin;Drug: Paracetamol<br>* If VAS score is more than 4 even after dolantin 1 mg/kg, 10 mg/kg paracetamol IV<br>* Other names: Parol;|
| Experimental: Low concentration<br>Epidural analgesia with 20 mL of 0.0625% bupivacaine + 2 mcg/mL fentanyl solution | Drug: Dolantin<br>* If VAS score is more than 4 even after additional dose, use dolantin 1 mg/kg<br>* Other names: Meperidin;Drug: Paracetamol<br>* If VAS score is more than 4 even after dolantin 1 mg/kg, 10 mg/kg paracetamol IV<br>* Other names: Parol;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change the need of bupivacaine for epidural analgesia. | primary aim of this study is to achieve VAS scores equal to or below 4 via different bupivacaine concentrations | In an hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Complication comparison | measure the number of treatment related complications and compare these measurements between the groups | 2 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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labor analgesia, dural tap, concentration