Outcomes of Neuraxial Anesthetic Technique on the Trial of Labor After Cesarean (TOLAC)
Labor Pain, Complications; Cesarean Section, Pregnancy
About this trial
This is an interventional treatment trial for Labor Pain focused on measuring trial of labor after cesarean, vaginal birth after cesarean, epidural vs combined spinal epidural
Eligibility Criteria
Inclusion Criteria:
- all patients meeting ACOG guidelines for TOLAC
- at least one previous elective cesarean delivery
- <40 weeks gestational age (GA)
- vertex singleton pregnancy with use of continuous fetal monitoring
Exclusion Criteria:
- Patient refusal of regional anesthetic or with contraindication for regional anesthesia
- BMI >40
- associated comorbidities such as gestational diabetes, preeclampsia, abnormal placentation
Sites / Locations
- Lyndon B. Johnson Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Epidural anesthesia
Combined spinal and epidural anesthesia
Trial of labor after cesarean with an epidural for anesthesia: Epidurals will be placed in a sterile fashion using a 17g Tuohy needle to locate the epidural space via loss-of-resistance to saline at the lumbar vertebral level. 3 ml of 1.5% lidocaine with 5ug/ml of epinephrine will then be used for test dose to exclude intrathecal or intravenous placement of the catheter. Epidural solution composed of 5ml of 0.2% ropivacaine and another 5 ml of 0.2% ropivacaine will then be administered.
Trial of labor after cesarean with a combined spinal and epidural (CSE) for anesthesia: the epidural space will be located with a 17g Tuohy needle and dural puncture performed with 25g Pencan needle via needle-through-needle technique. Spinal injection of 2ml 0.2% ropivacaine will then be performed and spinal needle removed. An epidural catheter will then be placed and test dose performed with 3 ml of 1.5% lidocaine with 5ug/ml of epinephrine. Maintenance dose will be via an epidural pump using 0.2% ropivacaine at a rate of 12 ml/hr.