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| ID | Type | Description | Link |
|---|---|---|---|
| 2013-001703-37 | EudraCT Number |
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Combined spinal-epidural (CSE) analgesia has become a widely accepted approach to provide analgesia for labour pain. Despite the increasingly widespread use of this technique, an optimal intrathecal drug regimen has not been established yet.
Several investigations using local anesthetics such as Bupivacaine, Levobupivacaine and Ropivacaine in CSE during labour have been published. But despite the reintroduction of Chloroprocaine recently there haven't been any investigations about spinal chloroprocaine. Chloroprocaine is already a long-know drug with a beneficial pharmacodynamic/kinetic profile. It is known for a very quick onset of action (2 - 3 minutes), high efficacy, rapid metabolism by plasma cholinesterases and short half-life both in mother and fetus.
Because of this beneficial profile, Chloroprocaine is widely used intrathecally for surgical anesthesia. Several investigations demonstrate that for surgical anesthesia doses Chloroprocaine ranging from 30 - 60 mg are used and that they have an effective surgical duration of 40 - 90 minutes.
Despite these "standards" for surgical anesthesia, little is known about spinal Chloroprocaine dose regimens. Therefore the primary goal of this study is to determine the minimum adequate dose of Chloroprocaine that is to be given spinally to a woman in labour using a CSE procedure. We will use the up-down sequential allocation to identify the median effective dose (ED50) or concentration (EC50).
The Effective dose in 95% of the population (ED95) can be estimated also from an up-down sequential allocation and will become an important valuable approximation of the clinical dose.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Chloroprocaine | Experimental | Up-down sequential allocation. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Spinal administration of chloroprocaine. | Drug | In order to determine the minimum effective dose that is to be given spinally, an up-down sequential allocation will be used. Efficacy of the analgesia will be evaluated by a 100mm visual analogue pain score (VAPS). There are two possible outcomes here:
|
| Measure | Description | Time Frame |
|---|---|---|
| Intensity of sensory blockade during the next 15 minutes after the application of the CSE. | The sensory blockade is determined by the difference in temperature sensation over the different dermatomes aided by ethylchloride spray. | During the next 15 minutes after the application of the CSE. |
| Intensity of the motor blockade during the next 15 minutes after the application of the CSE. | The motor blockade is determined by the adjusted Bromage scale:
Prior to the application of the CSE the patients are asked to perform the motor tests to exclude neurological disorders. | During the next 15 minutes after the application of the CSE. |
| The analgesic effect on the labor pain during the next 15 minutes after the application of the CSE. | Efficacy of the analgesia will be evaluated by a 100mm visual analogue pain score (VAPS). There are two possible outcomes here:
| During the next 15 minutes after the application of the CSE. |
| Measure | Description | Time Frame |
|---|---|---|
| Maternal heart rate during application of the CSE and the hour there after. | During application of the CSE and the hour there after. | |
| Maternal blood pressure during application of the CSE and the hour there after. | During application of the CSE and the hour there after. |
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Inclusion criteria :
Exclusion criteria :
Pregnant women in labour who received opiates or analgetics during the 6 hour period prior to CSE
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| Name | Affiliation | Role |
|---|---|---|
| Marc Coppens, MD | University Hospital, Ghent | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ghent University Hospital | Ghent | 9000 | Belgium |
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| Label | URL |
|---|---|
| Related Info | View source |
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| Maternal oxygen saturation during application of the CSE and the hour there after. | During application of the CSE and the hour there after. |
| Fetal heart rate during application of the CSE and the hour there after. | During application of the CSE and the hour there after. |