The Use of Electrical Stimulation for Determination of Epidural Catheter Placement

Study Overview
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Brief Summary
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We aim to address the problem of epidural failure. We theorize epidural failure can be due to inappropriate catheter movement and this may be related to the length of which the epidural catheter is inserted. We will use electrical stimulation to determine if the catheter moved in the sacral direction with insertion.

Detailed Description
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The research participants will be pregnant women in Labor and Delivery ward of Stanford University hospital who request an epidural for labor analgesia. In our study the patients will receive an epidural catheter in the same way as standard of care. The catheter will be inserted to 20cm and then electrically stimulated to document where it is placed by looking at the muscles effected. The catheter is then pulled back in 5cm increments and stimulated until the standard distance is achieved. For example, if loss of resistance happened at 5cm, the catheter would be inserted to 20cm, stimulated, pulled back to 15cm and stimulated, and finally to 10cm and stimulated. Electrical stimulation of epidural catheters for confirmation of placement is a published and accepted technique. In this study, we will perform electrical stimulation at incremental points during catheter pull back with documentation of where stimulation was seen.

Official Title
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The Use of Electrical Stimulation for Determination of Epidural Catheter Placement

Conditions
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Obstetric Pain, Anesthesia, Local

Intervention / Treatment
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* Diagnostic Test: Electrical Epidural Stimulation Test


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pregnant female requesting epidural for labor analgesia. Must meet standard inclusion criteria for safe epidural placement. Platelet count over 70,000, INR under 1.3. Exclusion Criteria: Unable to safely place epidural catheter due to commonly accepted patient factors.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Electrical Epidural Stimulation Test<br>Laboring women who request epidural analgesia will be given an electric stimulation at incremental points during catheter pull back with documentation of where stimulation was seen. | Diagnostic Test: Electrical Epidural Stimulation Test<br>* Electrical stimulation test measures sensory/motor responses<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence rate of sacral stimulation | Electrical stimulation will be performed at incremental points during catheter pull back with documentation of where stimulation was seen. | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Electrical Epidural Stimulation Test, Epidural Failure