Electric stimulation-guided epidural analgesia for vaginal delivery: A randomized prospective study.
<h4>Background</h4>The failure rate of epidural anesthesia using the loss of resistance technique is 13-23%.<h4>Objectives</h4>To investigate the efficacy of epidural electric stimulation-guided epidural analgesia in vaginal delivery.<h4>Study design</h4>An open l...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2019-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0209967 |
| _version_ | 1818726599981268992 |
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| author | Chung Hun Lee Sang Sik Choi Mi Kyoung Lee Jung Eun Kim Dong Ik Chung Mido Lee |
| author_facet | Chung Hun Lee Sang Sik Choi Mi Kyoung Lee Jung Eun Kim Dong Ik Chung Mido Lee |
| author_sort | Chung Hun Lee |
| collection | DOAJ |
| description | <h4>Background</h4>The failure rate of epidural anesthesia using the loss of resistance technique is 13-23%.<h4>Objectives</h4>To investigate the efficacy of epidural electric stimulation-guided epidural analgesia in vaginal delivery.<h4>Study design</h4>An open label randomized prospective study.<h4>Methods</h4>Laboring women were randomized to two groups: epidural catheter insertion using only a loss of resistance technique or a loss of resistance technique with confirmation by electric stimulation. Catheters in both groups were initially tested with 3 ml of 1% lidocaine and those with any evidence of motor blockade were considered intrathecal. Sensory blockade and an 11 point numerical rating score for pain were assessed 30 minutes after administration of an epidural bolus of 10 ml of 0.22% ropivacaine with fentanyl. Successful epidural analgesia was defined as a decrease of 2 or more in the pain score and a bilateral L1-T10 sensory blockade.<h4>Results</h4>Thirty-one patients were randomized to each group. The first 20 patients in each group were enrolled in a pilot study and were also included in the final analysis. One patient in the electric stimulation group was excluded owing to dural puncture by the Tuohy needle. One patient in each group demonstrated motor blockade after test dose and were considered failures. The number (% (95% confidence interval)) of successful cases were 29 out of 30 (97% (85, 100%)) in the electric stimulation group and 24 out of 31 (77% (61, 89%)) in the loss of resistance group (P = 0.053). However, analysis of only patients with absence of motor blockade revealed that 29 out of 29 (100% (92, 100%)) patients in the electric stimulation group and 24 of 29 (80% (63, 91%)) patients in the loss of resistance group had adequate analgesia (P = 0.024).<h4>Conclusions</h4>Although limited by lack of blinding, small study size and inclusion of pilot study data, this study suggests epidural electric stimulation improves the success rate of subsequent labor analgesia. |
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| format | Article |
| id | doaj.art-d748275d13aa405aa36223cb9cc18d7f |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-17T22:00:46Z |
| publishDate | 2019-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-d748275d13aa405aa36223cb9cc18d7f2022-12-21T21:30:59ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01141e020996710.1371/journal.pone.0209967Electric stimulation-guided epidural analgesia for vaginal delivery: A randomized prospective study.Chung Hun LeeSang Sik ChoiMi Kyoung LeeJung Eun KimDong Ik ChungMido Lee<h4>Background</h4>The failure rate of epidural anesthesia using the loss of resistance technique is 13-23%.<h4>Objectives</h4>To investigate the efficacy of epidural electric stimulation-guided epidural analgesia in vaginal delivery.<h4>Study design</h4>An open label randomized prospective study.<h4>Methods</h4>Laboring women were randomized to two groups: epidural catheter insertion using only a loss of resistance technique or a loss of resistance technique with confirmation by electric stimulation. Catheters in both groups were initially tested with 3 ml of 1% lidocaine and those with any evidence of motor blockade were considered intrathecal. Sensory blockade and an 11 point numerical rating score for pain were assessed 30 minutes after administration of an epidural bolus of 10 ml of 0.22% ropivacaine with fentanyl. Successful epidural analgesia was defined as a decrease of 2 or more in the pain score and a bilateral L1-T10 sensory blockade.<h4>Results</h4>Thirty-one patients were randomized to each group. The first 20 patients in each group were enrolled in a pilot study and were also included in the final analysis. One patient in the electric stimulation group was excluded owing to dural puncture by the Tuohy needle. One patient in each group demonstrated motor blockade after test dose and were considered failures. The number (% (95% confidence interval)) of successful cases were 29 out of 30 (97% (85, 100%)) in the electric stimulation group and 24 out of 31 (77% (61, 89%)) in the loss of resistance group (P = 0.053). However, analysis of only patients with absence of motor blockade revealed that 29 out of 29 (100% (92, 100%)) patients in the electric stimulation group and 24 of 29 (80% (63, 91%)) patients in the loss of resistance group had adequate analgesia (P = 0.024).<h4>Conclusions</h4>Although limited by lack of blinding, small study size and inclusion of pilot study data, this study suggests epidural electric stimulation improves the success rate of subsequent labor analgesia.https://doi.org/10.1371/journal.pone.0209967 |
| spellingShingle | Chung Hun Lee Sang Sik Choi Mi Kyoung Lee Jung Eun Kim Dong Ik Chung Mido Lee Electric stimulation-guided epidural analgesia for vaginal delivery: A randomized prospective study. PLoS ONE |
| title | Electric stimulation-guided epidural analgesia for vaginal delivery: A randomized prospective study. |
| title_full | Electric stimulation-guided epidural analgesia for vaginal delivery: A randomized prospective study. |
| title_fullStr | Electric stimulation-guided epidural analgesia for vaginal delivery: A randomized prospective study. |
| title_full_unstemmed | Electric stimulation-guided epidural analgesia for vaginal delivery: A randomized prospective study. |
| title_short | Electric stimulation-guided epidural analgesia for vaginal delivery: A randomized prospective study. |
| title_sort | electric stimulation guided epidural analgesia for vaginal delivery a randomized prospective study |
| url | https://doi.org/10.1371/journal.pone.0209967 |
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