Estimation of Pain During Epidural Analgesia During Labor (PERIDANS)

Centre Hospitalier Universitaire de Saint Etienne

Status

Completed

Conditions

Labor, Obstetric

Pain

Treatments

Device: Portable video pupillometer

Study type

Interventional

Funder types

Other

Identifiers

NCT02551354

1208078

Details and patient eligibility

About

Epidural regional anesthesia is a technique to eliminate or lessen pain during obstetric labor and childbirth. It consists in establishing a catheter into the epidural space and to block the transmission of pain sensations by injecting a local anesthetic and an opioid. In 10-25% of cases the epidural does not give perfect results, causing it to test its effectiveness, which is mainly done by questioning the patient on mitigation or disappearance of pain. This collaboration of patients is sometimes limited in our care structure by the inability to assess or express the pain, mainly due to cultural differences or language barriers, which can represent up to 15% of women in our institution. This led to develop objective measures of pain techniques used at the bedside.

Pupil diameter (PD) varies under the double influence of sympathetic system (Σ), dilator of the pupil, and parasympathetic system (pΣ).

The PD increases in response to painful stimulation, in proportion to the intensity of the nociceptive stimulus. This variation of PD has been proposed as a means of evaluation of pain in patients under general anesthesia, but has been little studied in conscious subjects.

There are other permanent changes in the PD, due to constant interaction between Σ and pΣ systems. Few data have been published to date on this PD variability (PDV).

Enrollment

40 patients

Sex

Female

Ages

18 to 45 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Obstetrical Labor
Able to rate their pain using VAS
dilatation of the cervix under 6 centimeters
Written consent

Exclusion criteria

- Not having a anesthesia consultation during the 48 hours before delivery
With a contra-indication for an epidural
To which an incident occurred during a previous epidural using a medication used in the study
Operated a unilateral or bilateral ocular surgery modifying the possibilities of variation of pupil diameter
general anesthesia in the seven days preceding delivery
Carry a pacemaker or heart grafted
Having Parkinson's disease history, insulin or non-insulin diabetes or chronic alcoholism
Having cardiac arrhythmia (atrial fibrillation or frequent extrasystoles)
Treated for hypertension by receptor antagonists of angiotensin type 2
anti-arrhythmic treatment or blocker,
Refusing to participate in the study
With a contra-indication for the use of ropivacaine and sufentanil.