Labor PainNCT01636999
Comparing Sedara to Butorphanol in Early Labor
A study testing 50% Nitrous Oxide/50% Oxygen in people with Labor Pain, run by West Penn Allegheny Health System at 1 site in United States.
Trial summary
Nitrous oxide (N2O) has been used for the treatment of labor pains for over 150 years. The longevity of its use in clinical practice can be attributed to its excellent safety profile, ease of administration, and familiarity of use among health-care providers. Read more about this study
- Who is it for?
- Ages 18 years and older, women onlyHealthy volunteers can take part
- Conditions the study is for
- Labor Pain
- What is being tested?
- 50% Nitrous Oxide/50% Oxygen
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 0 participants
- Where
- 1 siteUnited States
- Study dates
- Sep 2012to Sep 2014
- 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 years and older
- Women only
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Female
- 18 years of age or older
- Presents in active labor
- Full term pregnancy (at least 37 and up to 42 weeks gestation)
- Less than 5 cm cervical dilation on exam
Who cannot join
- Patients who have received prior regional or opioid analgesia
- Patients who have taken oral analgesics (narcotic or non-steroidal anti inflammatory drugs) within 6 hours prior to presentation
Trial locations and contacts
1 site in 1 country.
United States1 site
West Penn Hospital
Pittsburgh, Pennsylvania, 152064231
About this study
Official title: Comparing Pain Relief in Early Labor: Nitrous Oxide Versus Butorphonol Study
Nitrous oxide (N2O) has been used for the treatment of labor pains for over 150 years. The longevity of its use in clinical practice can be attributed to its excellent safety profile, ease of administration, and familiarity of use among health-care providers. Sedara is a self-administered 50% N2O, 50% oxygen gas mixture with pain relieving and anxiety reducing properties recently available for use in the United States (US) to treat various painful clnical situations, including labor pains.
In the US, epidural or intravenous administration of narcotic medications is one of the most common and frequently requested treatments for patients experiencing labor pains. Although generally considered safe, complications are common with epidurals, including fetal distress, low blood pressure in the mother, respiratory distress, and headache. In our hospital system, the use of the synthetic intravenous painkiller, Butorphanol, is a mainstay of treatment for labor pains. It too can have undesirable side effects in the mother, including low blood pressure and breathing problems.
Read more
Because Sedara has until recently been unavailable in the US, studies comparing its efficacy with other agents for labor pain have been confined to Europe, predominantly in the United Kingdom. Several studies have investigated the efficacy of Sedara versus inhalation and intravenous anesthetics in various countries. We have obtained several Sedara devices for use in the West Penn Allegheny Health System (WPAHS) Department of Anesthesiology and would like to examine its efficacy in our target population of women experiencing pain during early labor.
Hypothesis - Sedara will provide equivalent or superior pain relief among term, adult parturients in early labor (less than 5cm cervical dilation) compared to intravenous butorphanol.
Primary aim - Compare Sedara versus butorphanol in a single-blinded randomized trial with the main outcome measure being reduction in labor pains at various time intervals.
Our findings may be significant in terms of improving safety and efficacy of pain relief among women experienceing labor pains. Given that Sedara has not been previously studied in the US, the results may influence current obstetrical and pain management practices.
- Conditions
- Labor Pain
- Being tested
- 50% Nitrous Oxide/50% Oxygen
- Keywords
- Sedara, Nitrous Oxide, Butorphanol, Visual Analog Scale
- Medical subject headings
- Labor Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
50% Nitrous Oxide/50% OxygenDrug
Also called Sedara (FDA 510K Approval No. K101286)
The gas mixture is provided via the Sedara portable gas delivery system. This system is equipped with a non-rebreather mask which the patient holds over their mouth and nose. The delivery of the gas is only triggered by the patient's spontaneous breath. The gas machine will be provided to the patient to use as much as they like during the 60 minutes data collection period. The only dose which the machine allows to be administered is 50% Nitrous Oxide/50% oxygen.
| Study group | Role | What they receive |
|---|---|---|
| Butorphanol | Experimental | The main study arm will be examining how well a 50% Nitrous Oxide/50% Oxygen gas mixture is in reducing labor pains in term labor patients with less than 5 cm cervical dilation, compared to 2mg of Butorphanol (a common synthetic opiod used for labor pains in this setting). Receives: Drug: 50% Nitrous Oxide/50% Oxygen |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pain relief
The primary outcome measure of pain relief will be measured using a 100mm visual analog scale (VAS) immediately prior to administration of the test medication (either Sedara or butorphanol) and again at 5, 15, 30 and 60 minutes following the medication start time.
Measured: 60 minutes
Secondary outcomes (1)
Nausea, Sedation, Satisfaction
Secondary outcome measures collected include maternal reported level nausea, sedation, and overall satisfaction with analgesia using the Visual Analog Scores Scale at 0, 5, 15, 30 and 60 minutes.
Measured: 60 minutes
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 Jul 2012 (estimated)
- Study startSep 2012
- Primary completionSep 2014 (estimated)
- Study completionSep 2014 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (12)Papers the sponsor has linked to this study.
- Other trials for Labor PainStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 0 participants (actual)
Sponsor and investigators
- Lead sponsor
- West Penn Allegheny Health System
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Helene Finegold, MD, Principal investigator, Associate Residency Program DirectorChristopher Troianos, MD, Study chair, Residency Program Director
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01636999
- Sponsor's protocol ID
- 12-007
- Status last verified
- Oct 2020
- First submitted
- 6 Jul 2012
- Last updated
- 5 Oct 2020
- Results posted
- No
- Data monitoring committee
- Yes
Publications
Volmanen P, Palomaki O, Ahonen J. Alternatives to neuraxial analgesia for labor. Curr Opin Anaesthesiol. 2011 Jun;24(3):235-41. doi: 10.1097/ACO.0b013e328345ad18.
PubMed 21451402Rosen MA. Nitrous oxide for relief of labor pain: a systematic review. Am J Obstet Gynecol. 2002 May;186(5 Suppl Nature):S110-26. doi: 10.1067/mob.2002.121259.
PubMed 12011877Maslekar S, Gardiner A, Hughes M, Culbert B, Duthie GS. Randomized clinical trial of Entonox versus midazolam-fentanyl sedation for colonoscopy. Br J Surg. 2009 Apr;96(4):361-8. doi: 10.1002/bjs.6467.
PubMed 19283736Young P, Emery NC, Reisin R. Epidural analgesia for labor and delivery. N Engl J Med. 2010 Jul 22;363(4):395. No abstract available.
PubMed 20677364Viscomi CM. Randomized trial of epidural versus intravenous analgesia during labor. Obstet Gynecol. 1996 Mar;87(3):480-2. doi: 10.1016/0029-7844(96)82976-0. No abstract available.
PubMed 8598984Dickinson JE, Paech MJ, McDonald SJ, Evans SF. Maternal satisfaction with childbirth and intrapartum analgesia in nulliparous labour. Aust N Z J Obstet Gynaecol. 2003 Dec;43(6):463-8. doi: 10.1046/j.0004-8666.2003.00152.x.
PubMed 14712952Yeo ST, Holdcroft A, Yentis SM, Stewart A, Bassett P. Analgesia with sevoflurane during labour: ii. Sevoflurane compared with Entonox for labour analgesia. Br J Anaesth. 2007 Jan;98(1):110-5. doi: 10.1093/bja/ael327.
PubMed 17158129Volmanen P, Akural E, Raudaskoski T, Ohtonen P, Alahuhta S. Comparison of remifentanil and nitrous oxide in labour analgesia. Acta Anaesthesiol Scand. 2005 Apr;49(4):453-8. doi: 10.1111/j.1399-6576.2005.00639.x.
PubMed 15777291Talebi H, Nourozi A, Jamilian M, Baharfar N, Eghtesadi-Araghi P. Entonox for labor pain: a randomized placebo controlled trial. Pak J Biol Sci. 2009 Sep 1;12(17):1217-21. doi: 10.3923/pjbs.2009.1217.1221.
PubMed 19943458Kelly AM. Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med. 1998 Nov;5(11):1086-90. doi: 10.1111/j.1553-2712.1998.tb02667.x.
PubMed 9835471Yamamoto LG, Nomura JT, Sato RL, Ahern RM, Snow JL, Kuwaye TT. Minimum clinically significant VAS differences for simultaneous (paired) interval serial pain assessments. Am J Emerg Med. 2003 May;21(3):176-9. doi: 10.1016/s0735-6757(02)42255-3.
PubMed 12811707Lee JS, Hobden E, Stiell IG, Wells GA. Clinically important change in the visual analog scale after adequate pain control. Acad Emerg Med. 2003 Oct;10(10):1128-30. doi: 10.1111/j.1553-2712.2003.tb00586.x.
PubMed 14525749
Study at a glance
From the registry record, last updated by the sponsor on 5 Oct 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparing Pain Relief in Early Labor: Nitrous Oxide Versus Butorphonol Study
- ClinicalTrials.gov ID
- NCT01636999
- Acronym / sponsor ID
- 12-007
- Conditions
- Labor Pain
- Keywords
- Sedara, Nitrous Oxide, Butorphanol, Visual Analog Scale
- Study type
- Interventional
- Recruitment status
- Withdrawn
- Enrolment
- 0 participants (actual)
- Lead sponsor
- West Penn Allegheny Health SystemUniversity, hospital or other
- Study start
- Sep 2012
- Primary completion
- Sep 2014 (estimated)
- Study completion
- Sep 2014 (estimated)
- First posted
- 10 Jul 2012 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Nitrous oxide (N2O) has been used for the treatment of labor pains for over 150 years. The longevity of its use in clinical practice can be attributed to its excellent safety profile, ease of administration, and familiarity of use among health-care providers. Sedara is a self-administered 50% N2O, 50% oxygen gas mixture with pain relieving and anxiety reducing properties recently available for use in the United States (US) to treat various painful clnical situations, including labor pains.
In the US, epidural or intravenous administration of narcotic medications is one of the most common and frequently requested treatments for patients experiencing labor pains. Although generally considered safe, complications are common with epidurals, including fetal distress, low blood pressure in the mother, respiratory distress, and headache. In our hospital system, the use of the synthetic intravenous painkiller, Butorphanol, is a mainstay of treatment for labor pains. It too can have undesirable side effects in the mother, including low blood pressure and breathing problems.
Because Sedara has until recently been unavailable in the US, studies comparing its efficacy with other agents for labor pain have been confined to Europe, predominantly in the United Kingdom. Several studies have investigated the efficacy of Sedara versus inhalation and intravenous anesthetics in various countries. We have obtained several Sedara devices for use in the West Penn Allegheny Health System (WPAHS) Department of Anesthesiology and would like to examine its efficacy in our target population of women experiencing pain during early labor.
Hypothesis - Sedara will provide equivalent or superior pain relief among term, adult parturients in early labor (less than 5cm cervical dilation) compared to intravenous butorphanol.
Primary aim - Compare Sedara versus butorphanol in a single-blinded randomized trial with the main outcome measure being reduction in labor pains at various time intervals.
Our findings may be significant in terms of improving safety and efficacy of pain relief among women experienceing labor pains. Given that Sedara has not been previously studied in the US, the results may influence current obstetrical and pain management practices.
Study design
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- Single blind (participant)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Butorphanol | Experimental | Drug: 50% Nitrous Oxide/50% OxygenThe main study arm will be examining how well a 50% Nitrous Oxide/50% Oxygen gas mixture is in reducing labor pains in term labor patients with less than 5 cm cervical dilation, compared to 2mg of Butorphanol (a common synthetic opiod used for labor pains in this setting). |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Female
- 18 years of age or older
- Presents in active labor
- Full term pregnancy (at least 37 and up to 42 weeks gestation)
- Less than 5 cm cervical dilation on exam
Key exclusion criteria (2 listed)
- Patients who have received prior regional or opioid analgesia
- Patients who have taken oral analgesics (narcotic or non-steroidal anti inflammatory drugs) within 6 hours prior to presentation
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| 50% Nitrous Oxide/50% OxygenAlso: Sedara (FDA 510K Approval No. K101286)The gas mixture is provided via the Sedara portable gas delivery system. This system is equipped with a non-rebreather mask which the patient holds over their mouth and nose. The delivery of the gas is only triggered by the patient's spontaneous breath. The gas machine will be provided to the patient to use as much as they like during the 60 minutes data collection period. The only dose which the machine allows to be administered is 50% Nitrous Oxide/50% oxygen. | Drug | Butorphanol |
Primary outcome
Pain relief
Time frame: 60 minutes
The primary outcome measure of pain relief will be measured using a 100mm visual analog scale (VAS) immediately prior to administration of the test medication (either Sedara or butorphanol) and again at 5, 15, 30 and 60 minutes following the medication start time.
1 secondary outcome
Nausea, Sedation, Satisfaction
Time frame: 60 minutes
Results and safety
The study was withdrawn before enrolling participants, so there are no results.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 5 Oct 2020.
- Background: PubMed 21451402Volmanen P, Palomaki O, Ahonen J. Alternatives to neuraxial analgesia for labor. Curr Opin Anaesthesiol. 2011 Jun;24(3):235-41. doi: 10.1097/ACO.0b013e328345ad18.
- Background: PubMed 12011877Rosen MA. Nitrous oxide for relief of labor pain: a systematic review. Am J Obstet Gynecol. 2002 May;186(5 Suppl Nature):S110-26. doi: 10.1067/mob.2002.121259.
- Background: PubMed 19283736Maslekar S, Gardiner A, Hughes M, Culbert B, Duthie GS. Randomized clinical trial of Entonox versus midazolam-fentanyl sedation for colonoscopy. Br J Surg. 2009 Apr;96(4):361-8. doi: 10.1002/bjs.6467.
- Background: PubMed 20677364Young P, Emery NC, Reisin R. Epidural analgesia for labor and delivery. N Engl J Med. 2010 Jul 22;363(4):395. No abstract available.
- Background: PubMed 8598984Viscomi CM. Randomized trial of epidural versus intravenous analgesia during labor. Obstet Gynecol. 1996 Mar;87(3):480-2. doi: 10.1016/0029-7844(96)82976-0. No abstract available.
- Background: PubMed 14712952Dickinson JE, Paech MJ, McDonald SJ, Evans SF. Maternal satisfaction with childbirth and intrapartum analgesia in nulliparous labour. Aust N Z J Obstet Gynaecol. 2003 Dec;43(6):463-8. doi: 10.1046/j.0004-8666.2003.00152.x.
- Background: PubMed 17158129Yeo ST, Holdcroft A, Yentis SM, Stewart A, Bassett P. Analgesia with sevoflurane during labour: ii. Sevoflurane compared with Entonox for labour analgesia. Br J Anaesth. 2007 Jan;98(1):110-5. doi: 10.1093/bja/ael327.
- Background: PubMed 15777291Volmanen P, Akural E, Raudaskoski T, Ohtonen P, Alahuhta S. Comparison of remifentanil and nitrous oxide in labour analgesia. Acta Anaesthesiol Scand. 2005 Apr;49(4):453-8. doi: 10.1111/j.1399-6576.2005.00639.x.
- Background: PubMed 19943458Talebi H, Nourozi A, Jamilian M, Baharfar N, Eghtesadi-Araghi P. Entonox for labor pain: a randomized placebo controlled trial. Pak J Biol Sci. 2009 Sep 1;12(17):1217-21. doi: 10.3923/pjbs.2009.1217.1221.
- Background: PubMed 9835471Kelly AM. Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med. 1998 Nov;5(11):1086-90. doi: 10.1111/j.1553-2712.1998.tb02667.x.
- Background: PubMed 12811707Yamamoto LG, Nomura JT, Sato RL, Ahern RM, Snow JL, Kuwaye TT. Minimum clinically significant VAS differences for simultaneous (paired) interval serial pain assessments. Am J Emerg Med. 2003 May;21(3):176-9. doi: 10.1016/s0735-6757(02)42255-3.
- Background: PubMed 14525749Lee JS, Hobden E, Stiell IG, Wells GA. Clinically important change in the visual analog scale after adequate pain control. Acad Emerg Med. 2003 Oct;10(10):1128-30. doi: 10.1111/j.1553-2712.2003.tb00586.x.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Helene Finegold, MD principal investigator
Associate Residency Program Director
Christopher Troianos, MD study chair
Residency Program Director
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing 50% Nitrous Oxide/50% Oxygen in people with Labor Pain, run by West Penn Allegheny Health System at 1 site in United States.
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 5 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: withdrawn, as of the sponsor's last update on 5 Oct 2020. 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 United States. 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 was withdrawn before enrolling participants, so there are no results.
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?
Pain relief (time frame: 60 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 NCT01636999, which also lists 12 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 5 Oct 2020.