Evidence map›Paper›PMID 19095858›Full record

Trial reportAnesthesia and analgesia2009

A randomized trial of breakthrough pain during combined spinal-epidural versus epidural labor analgesia in parous women.

Stephanie R Goodman, Richard M Smiley, Maria A Negron, Paula A Freedman, Ruth Landau

2 registry-linked trialsOpen access · greenAbstract readComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Anesthesia and analgesia, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
1.8field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02768272 phase4completednot on this mapstarted 2016, after this paper: background citation

A Randomized Double Blind Clinical Trial Comparing Programed Intermittent Epidural Boluses (PIEB) Versus Patient Controlled Epidural Analgesia (PCEA) With Epidural or Combined Spinal-epidural (CSE) Technique

TypeinterventionalSponsorHospital Universitario La PazRan2016 to 2017Enrolled240ConditionsLabor Epidural AnalgesiaArmsPCEA vs PIEB, Epidural vs CSE
NCT05196256 phase3unknown statusnot on this mapstarted 2022, after this paper: background citation

A Double-blind, Randomized, Controlled, Pilot Study Comparing Three Different Anesthesic Techniques for Pregnant Women in Labour: Dural Puncture Epidural, Epidural and Combined Spinal Epidural. Evaluation of the Pain Control and the Hypotension Incidence All Along the Labour and Delivery

TypeinterventionalSponsorBrugmann University HospitalRan2022 to 2023Enrolled90ConditionsObstetric Pain, AnalgesiaArmsDural puncture, Combined spinal epidural analgesia, Epidural analgesia, Sufentanyl/Levobupivacaine
3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.

  1. Combined spinal-epidural versus epidural analgesia in labour.The Cochrane database of systematic reviews · 2012
    Pooled it
  2. Trial
  3. Trial
  4. Neuraxial analgesia for labour.BJA education · 2020
    Review
  5. Review
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Stephanie R GoodmanDepartment of Anesthesiology, Columbia University Medical Center, New York City, New York 10032, USA. srg24@columbia.ed
Richard M Smiley
Maria A Negron
Paula A Freedman
Ruth Landau
Columbia University Irving Medical Center · US

Funding

Beta2 adrenoceptor genotype and preterm laborR01HD048805 · NICHD · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI SMILEY, RICHARD M · 2005 to 2009
$1.5M
NICHD NIH HHS R01 HD048805
6 · The paper itself

Abstract

backgroundThere is controversy regarding the benefits and risks of combined spinal-epidural compared with epidural analgesia (CSE, EPID) for labor analgesia. We hypothesized that CSE would result in fewer patient requests for top-up doses compared to EPID.

methodsOne-hundred ASA physical status I or II parous women at term in early labor (<5 cm cervical dilation) requesting analgesia were randomized in double-blind fashion to the EPID group (epidural bupivacaine 2.5 mg/mL, 3 mL, followed by bupivacaine 1.25 mg/mL, 10 mL with fentanyl 50 microg) or the CSE group (intrathecal bupivacaine 2.5 mg with fentanyl 25 microg). Both groups received identical infusions of bupivacaine 0.625 mg/mL with fentanyl 2 microg/mL at 12 mL/h. The primary outcome variable was the number of top-up doses requested to treat breakthrough pain.

resultsThere was no significant difference between the two groups in the percentage of patients requesting top-up doses (44% CSE vs 51% EPID; 95% confidence interval of the difference -28% to +14%) nor in the need for multiple top-up doses (14% CSE vs 15% EPID). Visual analog scale scores were lower in the CSE group compared to the EPID group at 10 min after initiation of analgesia [median 0 cm (0, 0) vs 4 cm (1, 6) respectively, P < 0.001] and at 30 min [0 cm (0, 0) vs 0 cm (0, 1), respectively, P = 0.03].

conclusionsWe did not find a difference in the need for top-up doses in parous patients; however, CSE provided better analgesia in the first 30 min compared to EPID.

Indexed as

Analgesia, EpiduralAdultAnalgesia, ObstetricalAnalgesics, OpioidAnesthetics, LocalBupivacaineDouble-Blind MethodFemaleFentanylHumansInfusions, ParenteralIntractable PainLabor PainPain MeasurementParityPregnancyAnalgesics, OpioidAnesthetics, LocalBupivacaineFentanyl

Identifiers

PMID19095858
PMCPMC2670780
OpenAlexW1983444345

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.