Influence of Lumbar Ultrasound on Resident Learning Curve for Lateral Labor Epidural Placement
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 12/7/2018 |
| Start Date: | June 2014 |
| End Date: | March 2019 |
| Contact: | Michaela K Farber, MD MS |
| Email: | mkfarber@partners.org |
| Phone: | 617-732-8220 |
Pre-insertion Ultrasound Guidance for Labor Epidural Placement in the Lateral Position: A Randomized Controlled Trial of Image Reproducibility During Labor and Impact on Resident Learning Curve
The aim of this study is to evaluate the impact of lumbar spine ultrasound on the success
rate and efficiency of labor epidural placement in the lateral position. The investigators
hypothesize that ultrasound imaging of the lumbar spine of women in early labor will yield
similar ultrasound results when done immediately prior to epidural placement. The
investigators also hypothesize that the use of ultrasound with landmarks marked and depth to
the epidural space estimated will facilitate epidural placement in terms of both efficiency
(time required for placement) and efficacy of pain relief.
rate and efficiency of labor epidural placement in the lateral position. The investigators
hypothesize that ultrasound imaging of the lumbar spine of women in early labor will yield
similar ultrasound results when done immediately prior to epidural placement. The
investigators also hypothesize that the use of ultrasound with landmarks marked and depth to
the epidural space estimated will facilitate epidural placement in terms of both efficiency
(time required for placement) and efficacy of pain relief.
Several studies have demonstrated a significant benefit in pre-procedural ultrasound for
epidural placement by anesthesia residents, particularly when performed in the obese
population. To the investigators knowledge, however, no studies have evaluated this teaching
modality for the lumber epidural technique in the lateral position. Formalizing the
educational process for this less frequently performed, highly technical and critical skill
may have a profound impact on trainee learning curves, and may enhance the overall success
and efficiency of epidural placement, quality of analgesia provided, and safety of the
procedure.
epidural placement by anesthesia residents, particularly when performed in the obese
population. To the investigators knowledge, however, no studies have evaluated this teaching
modality for the lumber epidural technique in the lateral position. Formalizing the
educational process for this less frequently performed, highly technical and critical skill
may have a profound impact on trainee learning curves, and may enhance the overall success
and efficiency of epidural placement, quality of analgesia provided, and safety of the
procedure.
Pregnant Subjects
Inclusion Criteria:
- pregnant women
- 18 years or older
- in early labor (cervix dilated < 5 cm
- pain visual analog score (VAS) < 3, or both) requesting consultation by the anesthesia
team for anticipated epidural pain relief.
Exclusion Criteria:
- absolute contraindications of neuraxial anesthesia including patient refusal
- uncorrected coagulopathy
- infection at the skin site of epidural placement
- increased intracranial pressure, or untreated hemodynamic instability.
- In addition, patients with a history of scoliosis or spine surgery
- body mass index (BMI) >40 kg/m2
- allergy to local anesthetic, or allergy to opioids will be excluded.
Anesthesiologists
Inclusion criteria:
- Anesthesia residents or fellows who are performing the epidural technique in pregnant
subjects who agree to be part of the study.
- Anesthesia residents or fellows with prior experience in the lumbar epidural
technique, defined as having placed 20 or greater lumbar epidurals during their
residency and prior to enrollment.
Exclusion criteria:
- individuals who do not want to participate in the study.
We found this trial at
1
site
75 Francis street
Boston, Massachusetts 02115
Boston, Massachusetts 02115
(617) 732-5500
Phone: 617-759-1609
Brigham and Women's Hosp Boston’s Brigham and Women’s Hospital (BWH) is an international leader in...
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