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Analgesia for 2nd Trimester Termination of Pregnancy

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01563835
Recruitment Status : Terminated (Recruitment difficulty)
First Posted : March 27, 2012
Last Update Posted : October 13, 2014
Information provided by (Responsible Party):
Samuel Lunenfeld Research Institute, Mount Sinai Hospital

Brief Summary:
There has been very little investigation into the management of pain from 2nd trimester termination of pregnancy or unexpected fetal loss. The standard of practice in North America is usually intravenous patient controlled analgesia (IV PCA), using a narcotic wuch as fentanyl. The goal of this study is to compare the quality of recovery after termination of pregnancy using fentanyl IV PCA or patient controlled epidural analgesia (PCEA), a standard of care for live births. The study will be conducted as a randomized controlled trial.

Condition or disease Intervention/treatment Phase
Pain Drug: bupivacaine, fentanyl Drug: fentanyl Not Applicable

Detailed Description:

Epidural analgesia is known to provide superior analgesia for labour with minimal maternal and fetal side effects. This mode of analgesia is not usually offered to patients who require termination of their pregnancies or who suffer unexpected fetal losses, although they go through labour and delivery with likely more difficult psychological circumstances.

We plan to compare patient controlled epidural analgesia (PCEA) with intravenous patient controlled analgesia (IV PCA), for 2nd trimester terminations of pregnancy. We hypothesize that PCEA provides better quality of recovery than IV PCA. The previously validated Quality of Recovery - 40 questionnaire will be used to measure a patient's quality of recovery. The results of this study will determine the optimal method of pain relief for late termination of pregnancy or fetal loss.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 42 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Analgesia for 2nd Trimester Termination of Pregnancy: a Randomized Controlled Trial of Intravenous Versus Epidural Patient Controlled Analgesia
Study Start Date : March 2012
Actual Primary Completion Date : January 2014
Actual Study Completion Date : January 2014

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: Epidural (PCEA)
bupivacaine, fentanyl
Drug: bupivacaine, fentanyl
10mL of 0.125% of bupivacaine plus 50 mcg fentanyl, injected through an epidural catheter.
Other Names:
  • bupivacaine: Marcaine
  • fentanyl: fentanyl citrate

Active Comparator: IV PCA
Intravenous fentanyl patient controlled analgesia
Drug: fentanyl
fentanyl IV PCA with boluses 25-50 mcg, 3-6 minute lockout.
Other Name: fentanyl citrate

Primary Outcome Measures :
  1. Quality of Recovery - 40 score on discharge [ Time Frame: up to 5 days ]
    The primary outcome of this study will be the difference between IV PCA and PCEA groups in aggregate score of Quality of Recovery - 40 on discharge from hospital.

Secondary Outcome Measures :
  1. Duration of procedure [ Time Frame: 24 hours ]
    Duration of procedure from induction to abortion in hours

  2. Pain score [ Time Frame: 24 hours ]
    Visual analog pain score every 30 minutes during procedure

  3. Narcotic-related complications [ Time Frame: 24 hours ]
    Incidence of: nausea/vomiting, pruritis, sedation, respiratory depression.

  4. Epidural-related complications [ Time Frame: 24 hours ]
    Incidence of: hypotension, dural puncture, local anesthetic toxicity, neurological complications.

  5. Surgical intervention [ Time Frame: 24 hours ]
    Incidence of surgical intervention and any anesthetic required for intervention.

Information from the National Library of Medicine

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Ages Eligible for Study:   16 Years to 55 Years   (Child, Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • interruption of pregnancy between 12 and 23 6/7 weeks

Exclusion Criteria:

  • documented allergy to fentanyl or bupivacaine
  • coagulopathy
  • drug or narcotic abuse
  • contraindication to neuraxial analgesia
  • inability to comply with IVPCA or PCEA
  • inability to complete the QoR-40 questionnaire
  • TOP due to maternal problems

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01563835

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Canada, Ontario
Mount Sinai Hospital
Toronto, Ontario, Canada, M5G1X5
Sponsors and Collaborators
Samuel Lunenfeld Research Institute, Mount Sinai Hospital
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Principal Investigator: Jose CA Carvalho, MD MOUNT SINAI HOSPITAL
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Responsible Party: Samuel Lunenfeld Research Institute, Mount Sinai Hospital Identifier: NCT01563835    
Other Study ID Numbers: 12-03
First Posted: March 27, 2012    Key Record Dates
Last Update Posted: October 13, 2014
Last Verified: October 2014
Keywords provided by Samuel Lunenfeld Research Institute, Mount Sinai Hospital:
Termination of pregnancy
Additional relevant MeSH terms:
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Citric Acid
Sodium Citrate
Anesthetics, Local
Central Nervous System Depressants
Physiological Effects of Drugs
Sensory System Agents
Peripheral Nervous System Agents
Analgesics, Opioid
Adjuvants, Anesthesia
Anesthetics, Intravenous
Anesthetics, General
Calcium Chelating Agents
Chelating Agents
Sequestering Agents
Molecular Mechanisms of Pharmacological Action