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Regional Anaesthesia in Cesarean OperationsNCT07295080

Comparison of Dural Puncture Epidural and Standard Epidural Anesthesia Techniques in Elective Cesarean Deliveries

A study testing Dural puncture epidural (DPE) anaesthesia and standart epidural anesthesia in people with Regional Anaesthesia in Cesarean Operations, run by Ankara City Hospital Bilkent at 1 site in Turkey (Türkiye).

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Neuraxial techniques are the most effective form of labor analgesia in contemporary obstetric anesthesia practice, predominantly through the use of epidural (EPL) and combined spinal-epidural (CSE) techniques. Read more about this study

Who is it for?
Ages 18 to 40 years, women onlyHealthy volunteers can take part
What is being tested?
Dural puncture epidural (DPE) anaesthesia and standart epidural anesthesia
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
91 participants
Where
1 siteTurkey (Türkiye)
Study dates
1 Jan 2026to 1 May 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 40 years
  • Women only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Women scheduled for elective cesarean delivery
  • No comorbidities
  • Age between 18-40 years
  • Body mass index (BMI) < 35 kg/m²
  • Term pregnancy ≥ 37 weeks
  • No contraindications to neuraxial anesthesia (e.g., coagulopathy, infection, history of prior spinal surgery, etc.)

Who cannot join

  • Contraindications to neuraxial anesthesia
  • Refusal to participate in the study

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • Ankara city hospital

    Ankara, çankaya

Other trials in Turkey (Türkiye)

About this study

Neuraxial techniques are the most effective form of labor analgesia in contemporary obstetric anesthesia practice, predominantly through the use of epidural (EPL) and combined spinal-epidural (CSE) techniques. Although drug combinations employed in these methods have advanced, the onset time, block quality, and side effect profiles of both techniques still require further improvement.

The epidural technique is associated with minimal side effects; however, it may occasionally present variable block characteristics such as slow onset, inadequate sacral spread, unilateral or patchy sensory block, motor impairment, and epidural catheter failure.

Read more

The dural puncture epidural (DPE) technique is performed by inserting a spinal needle through the shaft of the epidural needle to create a single dural perforation, after which an epidural catheter is placed into the epidural space without administering any drugs into the cerebrospinal fluid (CSF). All medications for analgesia or anesthesia are delivered into the epidural space via the catheter. The dural puncture is thought to provide a conduit that facilitates the translocation of drugs from the epidural space into the subarachnoid space, which is believed to account for the clinical features observed with the dural puncture epidural technique advantageous in obstetric patients. Additionally, the process of dural puncture with a spinal needle through the epidural needle allows cerebrospinal fluid return to serve as a "confirmatory" definitive endpoint for the position of the epidural needle tip within the epidural space.

The investigators designed this study to determine whether the dural puncture epidural technique, compared with epidural, could improve the onset time and block characteristics of anesthesia in elective cesarean deliveries.

Compared with the epidural technique, the dural puncture epidural approach has been shown to improve the onset of sacral block as well as the spread of anesthesia and analgesia-characteristics that are particularly advantageous in obstetric patients. Additionally, the process of dural puncture with a spinal needle through the epidural needle allows cerebrospinal fluid return to serve as a "confirmatory" definitive endpoint for the position of the epidural needle tip within the epidural space.

The investigators designed this study to determine whether the dural puncture epidural technique, compared with epidural, could improve the onset time and block characteristics of anesthesia in elective cesarean deliveries.

Read the detailed description

This study aims to evaluate the effects of dural puncture epidural (DPE) versus standard epidural anesthesia on the time to surgical anesthesia onset in patients scheduled for elective cesarean section.

  • Study Population:

Pregnant women undergoing elective cesarean section

  • Compared Techniques:

Dural Puncture Epidural Group → A dural puncture will be performed with a 27G spinal needle before the placement of the epidural catheter.

Standard Epidural Group → An epidural catheter will be placed directly without dural puncture.

  • Primary Outcome:

Time from anesthesia administration to onset of surgical anesthesia (defined as time to achieve sensory block at the T5 dermatome level).

  • Secondary Outcomes:

Incidence of hypotension

Intraoperative ephedrine requirement

Need for additional doses

Post-dural puncture headache (PDPH)

Time to regression of sensory block

Motor block assessment (Bromage scale)

Study Design:

Prospective: Patients will be identified before anesthesia administration and evaluated going forward.

Randomized: Patients will be randomly assigned to either the dural ponksiyon epidural or standard epidural group.

Controlled: The two groups will be compared to analyze the effects.

Single-Center: The study will be conducted at a single hospital. Inclusion Criteria

  • Women scheduled for elective cesarean delivery
  • No comorbidities
  • Age between 18-40 years
  • Body mass index (BMI) < 35 kg/m²
  • Term pregnancy ≥ 37 weeks
  • No contraindications to neuraxial anesthesia (e.g., coagulopathy, infection, history of prior spinal surgery, etc.)

Parameters to Be Assessed

All parameters will be assessed by the investigator both intraoperatively and postoperatively in the ward. These include:

  • Sensory block level (evaluated every minute as a study-specific parameter)
  • Blood pressure
  • Heart rate
  • Oxygen saturation
  • Requirement for ephedrine
  • Requirement for additional epidural doses
  • Incidence of post-dural puncture headache (at 24 and 48 hours)
  • Motor block assessment (using the Bromage Scale)

Note: All evaluated parameters are part of standard monitoring, with the exception that sensory block level will be specifically assessed every minute for the purposes of this study.

-

Exclusion Criteria

  • Contraindications to neuraxial anesthesia
  • Refusal to participate in the study

Withdrawal and Termination Criteria

  • Patient's decision to withdraw from the study
  • Conversion to general anesthesia
  • Administration of intrathecal and/or intravenous drugs
Being tested
Dural puncture epidural (DPE) anaesthesia, standart epidural anesthesia
Keywords
dural puncture epidural anesthesia, epidural anesthesia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Dural puncture epidural (DPE) anaesthesiaOther

    The epidural space will be accessed using an 18G epidural needle, followed by dural puncture with a 27G spinal needle. Without administering any drug into the cerebrospinal fluid (CSF), an epidural catheter will then be inserted, through which anesthesia will be administered.Its placement will be confirmed with a test dose of 2 ml of 2% lidocaine. Following the test dose (after excluding signs of intrathecal or intravenous injection), a mixture consisting of 7.5 ml of 2% prilocaine, 7.5 ml of 0.5% bupivacaine, and 100 µg of fentanyl (2 ml) will be administered in 5-ml increments at 3-minute intervals.

  • standart epidural anesthesiaOther

    The epidural space will be accessed using an 18G epidural needle. An epidural catheter will then be inserted, through which anesthesia will be administered.Its placement will be confirmed with a test dose of 2 ml of 2% lidocaine. Following the test dose (after excluding signs of intrathecal or intravenous injection), a mixture consisting of 7.5 ml of 2% prilocaine, 7.5 ml of 0.5% bupivacaine, and 100 µg of fentanyl (2 ml) will be administered in 5-ml increments at 3-minute intervals.

Study groups in NCT07295080
Study groupRoleWhat they receive
dural puncture epiduralExperimentalThe epidural space will be accessed using an 18G epidural needle, followed by dural puncture with a 27G spinal needle. Without administering any drug into the cerebrospinal fluid (CSF), an epidural catheter will then be inserted, through which anesthesia will be administered.Its placement will be confirmed with a test dose of 2 ml of 2% lidocaine. Following the test dose (after excluding signs of intrathecal or intravenous injection), a mixture consisting of 7.5 ml of 2% prilocaine, 7.5 ml of 0.5% bupivacaine, and 100 µg of fentanyl (2 ml) will be administered in 5-ml increments at 3-minute intervals. At the completion of the injection (t0), the patient will be placed in the supine position with a 10-degree left tilt. Sensory block level will be assessed every minute using the pinprick test. Bilateral sensory block at the T5 dermatome will be accepted as adequate surgical anaesthesia.
Receives: Other: Dural puncture epidural (DPE) anaesthesia
standart epidural anesthesiaActive comparatorThe epidural space will be accessed using an 18G epidural needle. An epidural catheter will then be inserted, through which anesthesia will be administered.Its placement will be confirmed with a test dose of 2 ml of 2% lidocaine. Following the test dose (after excluding signs of intrathecal or intravenous injection), a mixture consisting of 7.5 ml of 2% prilocaine, 7.5 ml of 0.5% bupivacaine, and 100 µg of fentanyl (2 ml) will be administered in 5-ml increments at 3-minute intervals. At the completion of the injection (t0), the patient will be placed in the supine position with a 10-degree left tilt. Sensory block level will be assessed every minute using the pinprick test. Bilateral sensory block at the T5 dermatome will be accepted as adequate surgical anaesthesia.
Receives: Other: standart epidural anesthesia

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. onset time of sensory block

    The time from the administration of anesthesia to the onset of surgical anesthesia (the time it takes for the sensory block to reach the Thoracic 5 (T5) dermatome).

    Measured: 20 minutes

Secondary outcomes (6)
  1. Incidence of hypotension

    a 20% reduction from baseline blood pressure

    Measured: perioperative

  2. intraoperative ephedrine requirement

    total intraoperative ephedrine dose

    Measured: perioperative

  3. requirement for supplementery dosing

    Failure to achieve sensory block at the Torakal 5 (T5) level within 20 minutes or the occurrence of perioperative pain

    Measured: perioperative

  4. Postdural puncture headache (PDPH)

    Postoperative headaches will be evaluated at the 24th and 48th hours using the Visual Analog Scale (VAS)

    Measured: day 2

  5. Time to the onset of sensory block regression

    The duration of sensory block regression from the Thoracic 5 (T5) to the Thoracic 10 (T10) and Lumbar 1 (L1) dermatomal levels

    Measured: day 1

  6. Assessment of motor block

    The degree of motor block will be assessed using the Bromage score

    Measured: day 1

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Dec 2025
  2. Study start1 Jan 2026
  3. Primary completion1 May 2026
  4. Study completion1 May 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
91 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07295080
Sponsor's protocol ID
1251153
Status last verified
Jun 2026
First submitted
20 Nov 2025
Last updated
10 Jun 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Sharawi N, Williams M, Athar W, Martinello C, Stoner K, Taylor C, Guo N, Sultan P, Mhyre JM. Effect of Dural-Puncture Epidural vs Standard Epidural for Epidural Extension on Onset Time of Surgical Anesthesia in Elective Cesarean Delivery: A Randomized Clinical Trial. JAMA Netw Open. 2023 Aug 1;6(8):e2326710. doi: 10.1001/jamanetworkopen.2023.26710.

    PubMed 37526934
  • Rao WY, Xu F, Dai SB, Mei Z, Chen XP, Lv CC, Liu CL, Ngan Kee W, Chen XZ. Comparison of Dural Puncture Epidural, Epidural and Combined Spinal-Epidural Anesthesia for Cesarean Delivery: A Randomized Controlled Trial. Drug Des Devel Ther. 2023 Jul 18;17:2077-2085. doi: 10.2147/DDDT.S415684. eCollection 2023.

    PubMed 37484190
  • Chau A, Bibbo C, Huang CC, Elterman KG, Cappiello EC, Robinson JN, Tsen LC. Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques: A Randomized Clinical Trial. Anesth Analg. 2017 Feb;124(2):560-569. doi: 10.1213/ANE.0000000000001798.

    PubMed 28067707

Questions about this trial

What is this clinical trial studying?

A study testing Dural puncture epidural (DPE) anaesthesia and standart epidural anesthesia in people with Regional Anaesthesia in Cesarean Operations, run by Ankara City Hospital Bilkent at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 10 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

onset time of sensory block (time frame: 20 minutes). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07295080, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Jun 2026.

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