Improving Labour Induction Analgesia: Epidural Fentanyl Bolus at Epidural Initiation for Induction of Labour

• Status: Terminated
• Trial end date: 2020-11-02
• Target enrollment: 0
• Participant gender: Female

Summary

Labour pain can be intensified for labour inductions and women undergoing inductions often have earlier and more frequent requests for analgesia. Current evidence suggests that epidural analgesia effectively manages pain in labour, but may give rise to adverse effects for both the mother and neonate. Opioids are often added to epidurals to improve the quality of analgesia. Despite reassuring findings regarding epidural opioids, other investigators have found an association between epidural opioids and neonatal respiratory distress, lower Neurological and Adaptive Capacity scores, and reduced rates of breastfeeding. Given the heightened implications for the mother and neonate in situations requiring induction of labour, the desire for a positive outcome whilst still providing adequate maternal analgesia is paramount.

This study thus aims to investigate whether a preliminary epidural Fentanyl bolus at the initiation of the epidural may help to improve analgesia for women undergoing labour inductions for post-term pregnancy in a safe manner. Importantly, the main rationale of this proposed practice being that by achieving adequate epidural analgesia earlier in the labour induction, this may lead to better pain control overall and less overall requirements for epidural PCEA boluses and epidural "top-ups" as the induction progresses.

• Phase: Phase 1
• Accepts Healthy Volunteers?: Accepts Healthy Volunteers

Details

• Lead Sponsor: University of Saskatchewan
• Treatments: Analgesics, Opioid; Anesthetics; Anesthetics, Local; Fentanyl

Criteria

Inclusion Criteria:

• Healthy parturients

• Parturients presenting for labour induction for post-term pregnancy (i.e. pregnancy beyond 42 weeks gestational age)

• Parturients who have had an uncomplicated pregnancy

Exclusion Criteria:

• Parturients presenting for induction of labour for pre-labour (premature) rupture of membranes

• Parturients presenting for induction of labour for hypertensive disorders of pregnancy [including preeclampsia, eclampsia, HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets)]

• Parturients with maternal diabetes

• Fetal growth restriction

• Multiple gestation pregnancy

• Known or suspected Chorioamnionitis

• Known or suspected Abruptio placentae

• Oligohydramnios

• Parturients with cholestasis of pregnancy

• Known alloimmunization with fetal effects.

• Parturients with other chronic medical conditions or any complications related to pregnancy

• Participants who lack capacity to consent on their own behalf