Cross-legged Versus Traditional Sitting Position for the Success of Epidural Analgesia During Labor

NCT04754282 | Completed

• 2 other identifiers: APHP2011932020-A02267-32
• Study Type: interventional
• Target: 457
• Locations: 1 country
• Sites: 1

Brief Summary

The success of an epidural analgesia catheter placement depends on the parturient position. A poor posture can increase the number of punctures, patient discomfort, and risk of complications. An adequate position reverses lumbar lordosis, facilitating the access to the intervertebral space. In most cases, insertion of the epidural analgesia catheter is performed in sitting position or in lateral decubitus, the choice being generally guided by the preference of the anesthetist. According to anesthetists' experience in the obstetrical anesthesia unit at Necker-Enfants Malades hospital, a cross-legged sitting position is comfortable for parturients, restricts interfering movements during the procedure, and provides adequate widening of interspinous spaces. This position results in knees and hips flexion, tilting the pelvis backward and opening the interspinous spaces, while limiting muscular strain to maintain the position. However, literature on this matter is scarce. The aim of this study is to prove the superiority of the cross-legged position for successful placement of the epidural analgesia catheter at the first puncture without needle reorientation compared to a traditional sitting position on the edge of the bed.

Conditions

Epidural Analgesia for Labour and Delivery

Keywords

Epidural anesthesia; Sitting position; Cross-legged position; Labour; Pain; Obstetric

Outcome Measures

Primary Outcomes (1)

• Epidural analgesia success rate

  Percentage of epidural analgesia catheter placement success at first puncture without needle reorientation

  20 minutes

Secondary Outcomes (6)

• Patient's comfort

  20 minutes

• Patient's pain

  20 minutes

• Epidural analgesia success rate in obese patients

  20 minutes

• Successful rate of epidural analgesia catheter placement by residents

  20 minutes

• Operator satisfaction

  20 minutes

Study Arms (2)

Traditional sitting position

ACTIVE COMPARATOR

Expecting women are positioned in a traditional sitting position for epidural analgesia catheter placement during labour.

Other: Position of labouring women for epidural analgesia catheter placement : Traditional Sitting Position (TSP)

Cross-legged sitting position

EXPERIMENTAL

Expecting women are positioned in a crosse-legged sitting position for epidural analgesia catheter placement during labour.

Other: Position of labouring women for epidural analgesia catheter placement : Cross-legged Sitting Position (CSP)

Interventions

Position of labouring women for epidural analgesia catheter placement : Cross-legged Sitting Position (CSP) OTHER

Labouring women admitted to the delivery room of Necker Enfants Malades hospital, requesting an epidural analgesia for labour, and willing to participate in our study will be randomized in the Traditional Sitting Position (TSP) group on odd days or in the Cross-legged Sitting Position (CSP) group on even days. Patients in the TSP group seat on the edge of the bed, their feet laid on a support set next to the bed. Patients in the CSP group also seat on the edge the bed, but in a so-called "tailor" position, their knees bent, their hips flexed and in abduction, their feet under each contralateral thigh. The epidural catheter will be placed according to standard local practice in either of the groups.

Also known as: Cross-legged Sitting Position (CSP)

Cross-legged sitting position

Position of labouring women for epidural analgesia catheter placement : Traditional Sitting Position (TSP) OTHER

Labouring women admitted to the delivery room of Necker Enfants Malades hospital, requesting an epidural analgesia for labour, and willing to participate in our study will be randomized in the Traditional Sitting Position (TSP) group on odd days or in the Cross-legged Sitting Position (CSP) group on even days. Patients in the TSP group seat on the edge of the bed, their feet laid on a support set next to the bed. Patients in the CSP group also seat on the edge the bed, but in a so-called "tailor" position, their knees bent, their hips flexed and in abduction, their feet under each contralateral thigh. The epidural catheter will be placed according to standard local practice in either of the groups.

Also known as: Traditional Sitting Position (TSP)

Traditional sitting position

Eligibility Criteria

• Age: 18 Years+
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adult women admitted to the delivery room and requesting an epidural analgesia during labour
• Written informed consent
• French speaking patient

You may not qualify if:

• Patient with a contraindication to neuraxial analgesia
• Impossibility for the patient to seat in a cross-legged position
• No health insurance

Sponsors & Collaborators

• Assistance Publique - Hôpitaux de Paris: lead
• URC-CIC Paris Descartes Necker Cochin: collaborator

Study Sites (1)

Hôpital Necker-Enfants Malades

Paris, 75015, France

Location

Related Publications (1)

• Serey K, Osse L, Repesse X, Babou J, Banna L, Ayoub M, Elseblani R, Brebion M, Keita H. Cross-legged position versus traditional sitting position for epidural catheter insertion for labor analgesia: a non-randomized prospective study. Int J Obstet Anesth. 2024 Feb;57:103938. doi: 10.1016/j.ijoa.2023.103938. Epub 2023 Oct 11. No abstract available.

  PMID: 37891125 RESULT

MeSH Terms

Conditions

Pain

Condition Hierarchy (Ancestors)

Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Hawa KEITA-MEYER, MD, PhD

  Assistance Publique - Hôpitaux de Paris

  PRINCIPAL INVESTIGATOR

• Kevin SEREY, MD

  Assistance Publique - Hôpitaux de Paris

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 10, 2021
• First Posted: February 15, 2021
• Study Start: February 24, 2021
• Primary Completion: March 26, 2022
• Study Completion: March 26, 2022
• Last Updated: March 6, 2026

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share

Locations

FR (1)