Comparison of Ultrasound Guided Low Epidural Catheter Placement With Standard Epidural Catheter Placement
| Status: | Completed |
|---|---|
| Conditions: | Women's Studies |
| Therapuetic Areas: | Reproductive |
| Healthy: | No |
| Age Range: | 18 - 40 |
| Updated: | 4/2/2016 |
| Start Date: | January 2013 |
| End Date: | October 2013 |
| Contact: | TARIQ MALIK, MD |
| Email: | tmalik@dacc.uchicago.edu |
| Phone: | 7738343643 |
Comparison of Ultrasound Guided L5/S1 Epidural Catheter Placement With Standard Epidural Catheter Placement: A Randomized Trial
1. labor epidural quite often require bolus supplementation for better pain control
control. Quite often this is due to sparing of sacral nerves.
2. If epidural is placed low in the L5/S1 interspace using ultrasound, this may minimize
bolus requirement and improve patient labor experience.
control. Quite often this is due to sparing of sacral nerves.
2. If epidural is placed low in the L5/S1 interspace using ultrasound, this may minimize
bolus requirement and improve patient labor experience.
After consent patients will be randomized to one of the two groups: Control Group or the
Experimental Group. Patients will be blinded to the group assignment.
In each subject prior to labor epidural placement, intravenous access will be obtained and
if indicated fluid bolus will be given. There after heart and lung monitors will be placed.
Procedure will be placed in sitting position. Standard epidural kit will be used.
In the Control Group the patient will be seated. Low back area will be prepped and draped in
a sterile fashion. Lumbar interspaces will be identified clinically and epidural catheter
will be inserted in the interspace deemed most appropriate. Epidural space will be accessed
using loss of resistance to air technique. Once identified, a 20g open tip catheter will be
placed can into the space.
In the Experimental Group, subjects back will be scanned with an Ultrasound probe. The
interspace L5/S1, the lowest interspace in the spine will be identified and marked with the
marker on the skin. Thereafter epidural catheter will be place using the exactly the same
technique as used in the control group.
Once in place, catheter will be aspirated to rule out any intravascular placement.
Thereafter a test dose composed of 45 mg lidocaine and 15 microgram epinephrine will be
injected via the catheter to rule out any misplacement of catheter either in the intrathecal
space or blood vessels. Once proper placement confirmed, catheter will be dose with 10 ml
0.25% bupivacaine in 5 ml boluses.
The extent of block before the surgery will be evaluated at 30 minutes post injection.
Dermatomal level will be assessed on each side using ice. S1 and S2 dermatomal blockage will
be specifically assessed on each side by testing lateral margin of each foot (S1 dermatome)
and medial side of the popliteal fossa ( S2 dermatome).
Thereafter catheter will be connected to epidural solution containing 0.1% bupivacaine and 2
mic of Fentanyl per ml. Starting dose will be 10 ml per hr with bolus dose 5 ml q 30 minutes
self administered by patient if needed.
If pain relief is inadequate top-up doses will be given consisting of 5 ml 0.25% bupivacaine
times two 20 minutes part if needed. If no relief, dermatomal level will be reassessed. If
ones sided or unequal, catheter will be pulled back I-2 cm and re-dosed with bupivacaine
0.25% 5 ml times two if needed over twenty minutes. If still no relief and inadequate level,
catheter will be replaced.
Epidural catheter will be left in place till delivery. Patients will be clinically monitored
as part of routine anesthetic management. Once they deliver catheter is removed by nurses in
the labor and delivery unit and patients are sent to floor for recovery. Last evaluation
will take place on post delivery day number one to evaluate patient satisfaction and address
any concern patients may have.
Primary End points:
Primary purpose is to assess the ability of L5/S1 catheter to numb S1 or S2 dermatomes in
comparison to routine placement of epidural catheter Secondary outcome to be assessed VAS,
catheter manipulation or replacement between the two groups.
Experimental Group. Patients will be blinded to the group assignment.
In each subject prior to labor epidural placement, intravenous access will be obtained and
if indicated fluid bolus will be given. There after heart and lung monitors will be placed.
Procedure will be placed in sitting position. Standard epidural kit will be used.
In the Control Group the patient will be seated. Low back area will be prepped and draped in
a sterile fashion. Lumbar interspaces will be identified clinically and epidural catheter
will be inserted in the interspace deemed most appropriate. Epidural space will be accessed
using loss of resistance to air technique. Once identified, a 20g open tip catheter will be
placed can into the space.
In the Experimental Group, subjects back will be scanned with an Ultrasound probe. The
interspace L5/S1, the lowest interspace in the spine will be identified and marked with the
marker on the skin. Thereafter epidural catheter will be place using the exactly the same
technique as used in the control group.
Once in place, catheter will be aspirated to rule out any intravascular placement.
Thereafter a test dose composed of 45 mg lidocaine and 15 microgram epinephrine will be
injected via the catheter to rule out any misplacement of catheter either in the intrathecal
space or blood vessels. Once proper placement confirmed, catheter will be dose with 10 ml
0.25% bupivacaine in 5 ml boluses.
The extent of block before the surgery will be evaluated at 30 minutes post injection.
Dermatomal level will be assessed on each side using ice. S1 and S2 dermatomal blockage will
be specifically assessed on each side by testing lateral margin of each foot (S1 dermatome)
and medial side of the popliteal fossa ( S2 dermatome).
Thereafter catheter will be connected to epidural solution containing 0.1% bupivacaine and 2
mic of Fentanyl per ml. Starting dose will be 10 ml per hr with bolus dose 5 ml q 30 minutes
self administered by patient if needed.
If pain relief is inadequate top-up doses will be given consisting of 5 ml 0.25% bupivacaine
times two 20 minutes part if needed. If no relief, dermatomal level will be reassessed. If
ones sided or unequal, catheter will be pulled back I-2 cm and re-dosed with bupivacaine
0.25% 5 ml times two if needed over twenty minutes. If still no relief and inadequate level,
catheter will be replaced.
Epidural catheter will be left in place till delivery. Patients will be clinically monitored
as part of routine anesthetic management. Once they deliver catheter is removed by nurses in
the labor and delivery unit and patients are sent to floor for recovery. Last evaluation
will take place on post delivery day number one to evaluate patient satisfaction and address
any concern patients may have.
Primary End points:
Primary purpose is to assess the ability of L5/S1 catheter to numb S1 or S2 dermatomes in
comparison to routine placement of epidural catheter Secondary outcome to be assessed VAS,
catheter manipulation or replacement between the two groups.
Inclusion Criteria:
- Active labor age 18 or older
Exclusion Criteria:
- Known contraindications to epidural analgesia
- Any neurologic illness
- Fetal abnormalities
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