Dural Puncture Epidural Analgesia for Labor

Abstract Background The dural puncture epidural (DPE) technique is relatively a new technique of labor analgesia and has been advocated with the advantage of faster onset of pain relief. However, there are differences of opinion regarding the efficacy of the DPE technique and the size of the spinal needle to be used for the DPE. Various studies have suggested that DPE can only be done with a larger gauge of a spinal needle; however, recent studies have variable observations. We have compared the conventional lumbar epidural analgesia and DPE using a 27G pencil-point needle to assess the efficacy of DPE and its possible side effects. Results The time to achieve a 50% reduction in VAS was 7.06 ± 0.79 min in group CLE (n = 15) and 5.0 ± 1.06 min in group DPE (n = 15) (difference of two means was 2.06, 95% CI [1.36, 2.75], t = 5.99, p < 0.0001). The time to achieve VAS < 3 in group CLE was 14.93 ± 1.98 min, and in the group DPE, it was 10.13 ± 1.45 min (difference of two means was 4.8, 95% CI [3.52, 6.09], t = 7.55, p < 0.0001). The mode of delivery, APGAR scores, and side effects were comparable (p > 0.05). Conclusions DPE provided faster relief of labor pain than the conventional labor epidural analgesia. There were no added side effects by DPE in conventional lumbar epidural analgesia for labor. A 27G Whitacre pencil-point needle can be used for DPE. Trial registration CTRI, CTRI/2020/08/027060. Registered on 10/08/2020. Trial registered prospectively. CTRI website URL: http://ctri.nic.in

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A Systematic Review of DURAL Puncture Epidural Analgesia for Labor

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000552924.73942.d4 ◽

2019 ◽

Vol 39 (1) ◽

pp. 49

Author(s):

S. Layera ◽

D. Bravo ◽

J. Aliste ◽

Q. Tran

Keyword(s):

Systematic Review ◽

Epidural Analgesia ◽

Dural Puncture ◽

Dural Puncture Epidural

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The place of dural puncture epidural as a modern method of pain relief in labor

EMERGENCY MEDICINE ◽

10.22141/2224-0586.17.2.2021.230660 ◽

2021 ◽

Vol 17 (2) ◽

pp. 112-115

Author(s):

A.O. Zhezher ◽

Ye.M. Sulimenko ◽

O.A. Loskutov

Keyword(s):

Side Effects ◽

Epidural Analgesia ◽

Dural Puncture ◽

Epidural Block ◽

Needle Size ◽

Combined Spinal Epidural ◽

Dural Puncture Epidural ◽

Spinal Epidural ◽

The Impact

Childbirth is a physiological process that is accompanied by severe pain. Physiological and psychological factors may be involved in the pathological process. Increasing the concentration of catecholamines may help reduce uteroplacental perfusion. Pain during childbirth can lead to hyperventilation of the mother, which in turn can affect the acid-base status of the fetus and the state of the newborn. Prolonged pain can lead to the development of severe psychological disorders with a violation of the connection between mother and newborn. Acute pain during childbirth can transform into chronic in the postpartum period. The most effective are neuroaxial methods of analgesia: epidural analgesia, combined spinal-epidural analgesia and their modifications. Classical epidural analgesia has minimal adverse and side effects, but may be associated with a high incidence of insufficient analgesia. The frequency of inadequate epidural block reaches 23 %. Combined spinal-epidural analgesia, in contrast to epidural analgesia, has a higher quality of sensory block, but it is associated with a higher frequency of side effects such as hypotension, severe motor block, fetal arrhythmia. Since 2005, dural puncture epidural has been introduced into the practice of obstetric anesthesiologists as a method to improve the quality of classical epidural analgesia with minimal side effects of combined spinal-epidural analgesia. Data from existing studies show that dural puncture epidural potentially improves the quality of analgesia (faster onset of analgesia, better sacral coverage, lower incidence of inadequate block) compared with epidural analgesia and causes less hypotension, disorders of fetal heart rate compared with combined spinal-epidural analgesia. But the spinal needle size is important in achieving these effects. Further researches may be aimed at determining the duration of labor, the option of delivery and the possible impact of dural puncture epidural on the vegetative regulation of labor and a broader study of the impact of this method on the fetus and newborn.

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A systematic review of DURAL puncture epidural analgesia for labor

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2018.09.030 ◽

2019 ◽

Vol 53 ◽

pp. 5-10 ◽

Cited By ~ 2

Author(s):

Sebastián Layera ◽

Daniela Bravo ◽

Julián Aliste ◽

De Q. Tran

Keyword(s):

Systematic Review ◽

Epidural Analgesia ◽

Dural Puncture ◽

Dural Puncture Epidural

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Dural puncture epidural analgesia for labor: a randomized comparison between 25-gauge and 27-gauge pencil point spinal needles

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-100608 ◽

2019 ◽

Vol 44 (7) ◽

pp. 750-753

Author(s):

Felipe Contreras ◽

Juan Morales ◽

Daniela Bravo ◽

Sebastián Layera ◽

Álvaro Jara ◽

...

Keyword(s):

Epidural Analgesia ◽

Local Anesthetic ◽

Motor Block ◽

Dural Puncture ◽

Onset Time ◽

Sensory Block ◽

Postural Headache ◽

Block Height ◽

Dural Puncture Epidural ◽

Initial Bolus

BackgroundThis double-blind, randomized trial compared dural puncture epidural analgesia (DPEA) for labor using 25-gauge and 27-gauge pencil point spinal needles. We hypothesized that both needle sizes would result in similar onset time (equivalence margin=2.5 min) and therefore designed the study as an equivalence trial.MethodsOne hundred and forty patients undergoing labor were randomized to DPEA with 25-gauge (n=70) or 27-gauge (n=70) pencil point spinal needles. After the placement of the epidural catheter, a bolus of 20 mL of bupivacaine 0.125% and fentanyl 2 µg/mL was administered to all subjects. Thereafter, patients received boluses of 12 mL of bupivacaine 0.125% every 2 hours as needed.A blinded investigator recorded the onset time (defined as the temporal interval required to achieve a pain score ≤1 on a 0–10 scale), S2 block, sensory block height (30 min after the initial bolus of local anesthetic), presence of motor block (30 min after the initial bolus of local anesthetic), number of top-up doses required during labor and incidence of postural headache.ResultsOut of the 140 recruited patients, 135 were retained for analysis. Compared with their 27-gauge counterparts, 25-gauge pencil point spinal needles provided a 1.6 min shorter DPEA onset (95% CI of the difference of the means: −3.2 to −0.1 min). However, there were no intergroup differences in terms of S2 block, sensory block height, motor block, number of top-up doses and incidence of postural headache.ConclusionDural puncture epidural analgesia with 25-gauge pencil point spinal needles provides a 1.6 min shorter onset time than DPEA with 27-gauge spinal needles. Although statistically significant, such a difference may not be clinically relevant. Further investigation is required to compare 25-gauge and 27-gauge spinal needles for DPEA in the setting of different local anesthetic infusion strategies.Trial registration numberNCT03389945.

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