Dural Puncture Epidural VS Standard Epidural on Physician Top-ups During Labour Analgesia (DPE)
Obstetric Pain, Labor Pain, Anesthesia
About this trial
This is an interventional treatment trial for Obstetric Pain focused on measuring Dural puncture epidural, Epidural, Low dose bupivacaine
Eligibility Criteria
Inclusion Criteria:
- Healthy pregnant women (ASA 1 and 2) requesting epidural analgesia during labour.
- Primiparous and multiparous parturients at term gestation (37 to 42 weeks).
- Women 18 years old and older.
- Administration of epidural analgesia between 7am and 4pm on weekdays.
- Singleton and vertex presentation foetus.
- Cervical dilatation ≤ 5 cm.
- BMI ≤ 40.
- French speaking
Exclusion Criteria:
- Pregnancy diseases such as gestational hypertension, preeclampsia and gestational diabetes.
- Contraindications to neuraxial analgesia: thrombocytopenia < 70 x 109/L, spinal cord anomalies, anticoagulation therapy, etc.
- Known important fetal anomalies.
- Allergy to any of the medications used in the study.
- Suspected chorioamnionitis with spontaneous premature rupture of membranes (PROM).
- Difficulty understanding and speaking French.
Sites / Locations
- CIUSSS de l'Est de l'Île de MontréalRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Dural puncture epidural (group DPE)
Standard epidural (group EPL)
The epidural space will be identified in the seated position between the L2 and L5 interspaces with a 17G-10 cm Tuohy epidural needle (CHS ®, Oakville, ON, Canada) using a loss of resistance to saline technique. In both groups, a needle-through-needle technique will be performed using a 25G 5-inch Whitacre spinal needle (BD®, Franklin Lakes, NJ, USA). In group DPE, a single dural puncture with confirmation of free-flow CSF will be performed. If there is no free-flow CSF return through the spinal needle, the epidural catheter will be threaded 4-5cm in the epidural space and the patient will still be assigned to the DPE group, as per "intent-to-treat" protocol.
The epidural space will be identified in the seated position between the L2 and L5 interspaces with a 17G-10 cm Tuohy epidural needle (CHS ®, Oakville, ON, Canada) using a loss of resistance to saline technique. In both groups, a needle-through-needle technique will be performed using a 25G 5-inch Whitacre spinal needle (BD®, Franklin Lakes, NJ, USA).In Group EPL, no dural puncture will be performed and the catheter will be threaded 4-5cm in the epidural space.