Clinical Research Directory

Dural Puncture Epidural With 27G vs 26G Needles Versus Standard Epidural for Elective Cesarean Delivery

The goal of this clinical trial is to learn whether the dural puncture epidural (DPE) technique shortens the onset time of surgical anesthesia compared with the standard epidural technique in healthy women undergoing elective cesarean delivery, and whether the size of the spinal needle used for dural puncture (27-gauge vs 26-gauge pencil point) changes this effect. The main question it aims to answer is: Does DPE with a 27G or 26G spinal needle reduce the time from completion of epidural drug injection to bilateral T5 sensory block compared with standard epidural anesthesia? Researchers will also compare hypotension, ephedrine use, need for additional epidural local anesthetic, motor block, sensory block regression, and post-dural puncture headache among the three groups. Participants will be randomly assigned to one of three groups: standard epidural, DPE with a 27G spinal needle, or DPE with a 26G spinal needle. In all groups, the same epidural drug mixture will be given through the epidural catheter, and no drug will be injected into the cerebrospinal fluid. Sensory block will be tested every minute after injection, and headache will be checked at 24 and 48 hours after surgery.

Comparing Spinal, Epidural, and Dural Puncture Epidural Anesthesia for Cesarean Delivery: Hemodynamics and Block Quality

The goal of this clinical trial is to compare three regional anesthesia techniques (spinal, epidural, and dural puncture epidural anesthesia) in healthy pregnant women undergoing planned (elective) cesarean delivery. The main questions it aims to answer are: Which technique causes less low blood pressure (maternal hypotension) and requires less vasopressor medication during surgery? Which technique provides faster and more effective surgical anesthesia? Spinal anesthesia works quickly but often causes a sudden drop in blood pressure, while epidural anesthesia is more stable but slower and sometimes incomplete. Dural puncture epidural is a newer technique that may combine the speed of spinal anesthesia with the stability of epidural anesthesia. A total of 120 participants will be randomly assigned in equal numbers to one of the three groups. Researchers will compare the groups for blood pressure and heart rate changes, number of hypotension episodes, vasopressor use, time to reach adequate block (T6 level), block quality, need for additional pain medication, and side effects such as nausea, vomiting, and headache. Newborn well-being will be assessed with Apgar scores and umbilical cord blood gas analysis. Maternal and surgeon satisfaction will also be recorded.

Shared Decision-Making During Anesthesia Consent for Elective Cesarean Delivery

Shared decision-making (SDM) is the accepted ethical and legal standard for informed consent, but it is not known how it operates in anesthesia consent for cesarean delivery. Neuraxial anesthesia is recommended for most cesarean deliveries, and many anesthesiologists therefore present it as the only primary option, with general anesthesia (GA) available only as a rescue. Others present GA as a genuine alternative the patient can choose. This study will observe the existing variation in practice and will not change care. A trained observer will attend the pre-operative anesthesia consent encounter for women having an elective cesarean delivery at BC Women's Hospital and record which options were presented, using the observer-rated OPTION-5 instrument. Written research consent and a questionnaire follow 24-48 hours after delivery, and include the 9-item Shared Decision Making Questionnaire (SDM-Q-9). The primary aim is to compare patient-perceived SDM (SDM-Q-9) between consultations in which GA was offered as a genuine primary option and those in which it was not. This study hypothesizes that the SDM-Q-9 score will be higher when GA was offered as a primary option. Secondary aims are to describe observed SDM, decisional conflict, provider-level variation, and women's preference to be offered a choice in a future cesarean. The findings will inform a planned interventional trial of a standardized consent model.

CODEPAD (Collaborative Outcomes of DEpression and Pain Associated With Delivery)

Postnatal depression affects about 10-15% of women after childbirth. Approximately 3-5% of women experience a moderate-to-severe depression that requires medical attention. This study aims to investigate the implication of pain relief choice in reducing the postnatal depression of women who deliver their babies.