Enrolling by Invitation

NCT Number: NCT05514431

Conversion of Labor Analgesia for Intrapartum Cesarean Delivery: DPE v CSE v Epidural

As the dural puncture epidural (DPE) is increasing in popularity for labor analgesia, it is important to understand how it impacts outcomes in parturients. Prior studies have found epidural catheters placed via the combined-spinal epidural technique have greater success at surgical conversion for cesarean delivery than catheters placed via traditional techniques. The investigators aim to determine if epidural catheters placed by a DPE technique will also have an increased successful conversion for surgical anesthesia by conducting a retrospective review of all CD during the study period. If an association is found, this could be another benefit of DPE for labor analgesia.

Enrolling by Invitation

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Key information

Conditions

Anesthesia Agnosia Analgesia Nervous System Diseases Neurobehavioral Manifestations Neurologic Manifestations Pathological Conditions, Signs and Symptoms Perceptual Disorders Signs and Symptoms

Sex eligibility

Female

Study type

Observational

Primary location

BC Women's Hospital, Vancouver, British Columbia, Canada

About this study

Electronic medical records will be searched for all intrapartum cesarean deliveries performed from February 1, 2017 through May 30, 2021 (Mayo Clinic) and from January 1, 2022 to December 31, 2022 (BC Women's Hospital).

From this list, patients that had cesarean delivery with an epidural catheter will be identified and split into three groups based on the type of neuraxial block listed in the block document of the patient's medical record:

Group 1 - Dural puncture epidural Group 2 - Epidural Group 3 - Combined spinal-epidural

Failure of epidural catheter conversion to surgical anesthesia at cesarean delivery will be defined by requirement of a second anesthetic at the time of surgery, including spinal or repeat epidural techniques or general anesthesia at the time of cesarean delivery

Data Collection: All data will be collected retrospectively from the electronic medical record.

Type of neuraxial block
Size of needle used for DPE or CSE: 25 g or 27 g
Duration of time from epidural placement until CD (Time of epidural placement; time of delivery)
Number of epidural top-ups
Type and amount of medication used for conversion to surgical anesthesia
Urgency of cesarean delivery
Airway documentation indicative of general anesthesia (if applicable)
Length (time) of surgical procedure

Other data collected from patient electronic records will include:

Maternal demographics: Parity, number of prior cesarean deliveries, weight, height, BMI
Fetal characteristics (birthweight, Apgar scores)
Indication for cesarean delivery

Fetal distress (NRFHT, fetal intolerance of labor)
Failure of labor (Failure to dilate, failure to descend)
Failed operative vaginal delivery
Maternal comorbidity
Emergency (cord prolapse, abruption, uterine rupture)
Anesthesiologist (Fellowship trained: Y/N) at time of cesarean delivery

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Women with neuraxial labor analgesia (CSE, DPE, or Epidural) who have an intrapartum cesarean delivery
Singleton gestation

Exclusion criteria

No local anesthetic given in epidural for cesarean delivery (in emergency situation)
Inadvertent dural puncture

Treatment and study plan

Epidural

Procedure

Traditional epidural catheter placement

Dural Puncture Epidural (DPE) technique

Procedure

Epidural catheters placed via DPE technique

Combined Spinal-Epidural (CSE) technique

Procedure

Epidural catheters placed via CSE technique

Primary outcomes

Conversion to surgical anesthesia

Time frame: Baseline

Number of subject to have success of conversion to surgical anesthesia for intrapartum cesarean delivery

Sponsors and collaborators

Lead sponsor

Mayo Clinic

Other

Collaborators

University of British Columbia

Registry information

Official study title

Conversion of Labor Analgesia for Intrapartum Cesarean Delivery: Dural Puncture Epidural vs Combined Spinal Epidural vs Epidural

Important dates

Study start: 2017
Primary completion: 2026
Study completion: 2026
First posted: Aug 24, 2022
Registry last updated: Aug 17, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Published trials that share one or more normalized conditions with this study.

Completed