Finding the Best Dose of Bupivacaine for Epidural Pain Relief During Labor Using Lidocaine Test Dose

What this Trial Is About

Researchers are evaluating the optimal dose of bupivacaine needed after a lidocaine test dose to provide effective pain relief in 90% of women undergoing labor induction or augmentation. This trial compares two epidural techniques dural puncture epidural DPE and traditional epidural EPL. The main goal is to determine the dose of bupivacaine that achieves comfort with a pain score below 3 at 30 minutes after administration using a biased coin up-down allocation method. Participants will be randomly assigned to receive an epidural catheter via either the DPE or EPL technique. The first patient in each group receives 25 mg of bupivacaine, and subsequent doses are adjusted in 2.5 mg increments based on the previous patients response. If pain relief is not successful, the dose increases if successful, the dose is decreased or maintained according to a set probability, aiming to find the dose effective for 90% of patients. Throughout the study, participants pain levels are monitored at 30 minutes after the dose. Researchers measure the primary outcome of achieving a pain score less than 3 using the Numerical Rating Scale. The study is randomized and quadruple-masked, ensuring unbiased assessment. Participants will be monitored during labor analgesia, and the study is expected to complete by June 2027.

ED90 of Bupivacaine After Lidocaine Test Dose With DPE and EPL