Combined spinal epidural (CSE) and epidural (EPL) are the two commonly used neuraxial techniques for labor analgesia. CSE has faster onset but late recognition of epidural failure. EPL produces late onset of analgesia, and quality may not be reliable. Dural puncture epidural (DPE), a modification of the CSE, is a procedure in which the dura will be perforated using a spinal needle with no administration of intrathecal medication. This technique has a faster onset and improved block quality in terms of the caudal spread of analgesia that can be attributed due to the translocation of medication from epidural space into the dural sac. DPE is found to be more effective for labor analgesia with a low dose of local anesthetics with fewer maternal and fetal side effects than the other techniques.
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