Conversion of Labor Analgesia for Intrapartum Cesarean Delivery: DPE v CSE v Epidural

Study Overview
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Brief Summary
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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.

Detailed Description
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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. Type of neuraxial block Size of needle used for DPE or CSE: 25 g or 27 g Duration of time from epidural placement until CD (Time of epidural placement; time of delivery) Number of epidural top-ups Type and amount of medication used for conversion to surgical anesthesia Urgency of cesarean delivery Airway documentation indicative of general anesthesia (if applicable) Length (time) of surgical procedure Other data collected from patient electronic records will include: Maternal demographics: Parity, number of prior cesarean deliveries, weight, height, BMI Fetal characteristics (birthweight, Apgar scores) Indication for cesarean delivery Fetal distress (NRFHT, fetal intolerance of labor) Failure of labor (Failure to dilate, failure to descend) Failed operative vaginal delivery Maternal comorbidity Emergency (cord prolapse, abruption, uterine rupture) Anesthesiologist (Fellowship trained: Y/N) at time of cesarean delivery

Official Title
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Conversion of Labor Analgesia for Intrapartum Cesarean Delivery: Dural Puncture Epidural vs Combined Spinal Epidural vs Epidural

Conditions
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Anesthesia, Analgesia

Intervention / Treatment
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* Procedure: Epidural
* Procedure: Dural Puncture Epidural (DPE) technique
* Procedure: Combined Spinal-Epidural (CSE) technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women with neuraxial labor analgesia (CSE, DPE, or Epidural) who have an intrapartum cesarean delivery Singleton gestation Exclusion Criteria: No local anesthetic given in epidural for cesarean delivery (in emergency situation) Inadvertent dural puncture
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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Dural puncture epidural (DPE)<br>Subjects that received neuraxial labor analgesia of dural puncture epidural for intrapartum cesarean delivery | Procedure: Dural Puncture Epidural (DPE) technique<br>* Epidural catheters placed via DPE technique<br>|
| Combined spinal epidural (CSE)<br>Subjects that received neuraxial labor analgesia of combined spinal epidural for intrapartum cesarean delivery | Procedure: Combined Spinal-Epidural (CSE) technique<br>* Epidural catheters placed via CSE technique<br>|
| Traditional Epidural<br>Subjects that received neuraxial labor analgesia of epidural for intrapartum cesarean delivery | Procedure: Epidural<br>* Traditional epidural catheter placement<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Conversion to surgical anesthesia | Number of subject to have success of conversion to surgical anesthesia for intrapartum cesarean delivery | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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epidural, cesarean, parturient