Dural Puncture Epidural technique proved to be effective over conventional epidural technique

According to a study published in the Anesthesia & Analgesia journal, the use of dural puncture epidural (DPE) had faster onset of action as compared to the conventional epidural (EP) procedure for neuraxial analgesia. Also, DPE along with programmed intermittent epidural bolus (PIEB) was found to be safe and offered highest drug-sparing effect.

This randomized controlled trial by Yujie Song and researchers was performed to study if DPE technique plus PIEB offers added benefits for analgesia onset, local anesthetic drug intake, and adverse effects as compared to EP or DPE procedures with continuous epidural infusion (CEI) in nulliparous women.

Overall, 116 nulliparous women with a visual analog scale (VAS) pain score less than 50 mm and cervical dilation less than 5 cm were recruited for this study. These women were categorised into groups as: EP + CEI group (38 women); DPE + CEI group (40 women); DPE + PIEB group (38 women). A combination of 10 mL of ropivacaine 0.1% and sufentanil 0.3 µg/mL was used as analgesia which was sustained with the same solution at 8 mL/h in the three groups. Severe pain not modifiable by patient-controlled epidural analgesia (PCEA) was managed via boluses of 5 mL of ropivacaine 0.125%. “Time to adequate analgesia” was considered as the primary outcome.

As compared to the EP + CEI group, the patients in the DPE + CEI and DPE + PIEB groups accomplished quicker adequate anesthesia. Least PCEA boluses and lowest ropivacaine use in an hour was observed in DPE + PIEB group. No differences in the secondary outcomes like labor duration, delivery mode, Bromage scores, adverse effects, and among three groups were prevalent.

DPE + PIEB can be used without the risk side effects (maternal or neonatal), noted the study researchers.