Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques: A Randomized Clinical Trial

Chau, Anthony; Bibbo, Carolina; Huang, Chuan; Elterman, Kelly; Cappiello, Eric; Robinson, Julian N.; Tsen, Lawrence C.

doi:10.1213/ane.0000000000001798

Cited by 189 publications

(99 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This corroborates the results in this study that DXMS pretreatment is effective in reducing the incidence of postoperative lower back pain in epidural labor analgesia. In the study of Chau et al ( 16 ) and Wilson et al ( 17 ), it was shown that the number of punctures is a direct factor affecting postoperative lower back pain. Therefore, the effect of DXMS on patients with different times of punctures was investigated and it was found that either with one puncture or many times of puncture, the incidence of postoperative lower back pain in the observation group was significantly lower than that in the control group.…”

Section: Discussionmentioning

confidence: 99%

Local injection of dexamethasone helping to prevent lower back pain after epidural delivery analgesia

Yang

Liu

et al. 2018

Exp Ther Med

View full text Add to dashboard Cite

This report aims to retrospectively analyze the clinical effect of local pretreatment with dexamethasone (DXMS) on lower back pain after epidural labor analgesia. Patients with epidural labor analgesia treated in People's Hospital of Rizhao from January 2014 to December 2016 were studied. All 368 cases involved were pregnant primipara with full-term single birth. Parturient received injection of DXMS and lidocaine mixture around the epidural puncture point was the observation group (n=188), and parturient received injection of 0.9% sodium chloride and lidocaine mixture around the epidural puncture point was the control group (n=180). The incidence and degree of lower back pain postoperatively in the two groups were evaluated by pain visual analogue scale method. The incidence of lower back pain at 48 h, 72 h after operation in observation group was significantly lower than that in control group (p<0.05). Among patients undergoing one puncture and more than one puncture, the incidence of postoperative lower back pain in the observation group was significantly lower than that in the control group (59.26%) (p<0.05). Among the parturient with spontaneous delivery, the incidence of postoperative lower back pain in the observation group was significantly lower than that in the control group (p=0.028). Among the cesarean section patients, the incidence of pain in observation group was significantly lower than that in control group (p=0.019). At 48 and 72 h after operation, severe pain in the observation group was significantly less than that in the control group (p<0.05). DXMS local pretreatment can significantly reduce the incidence of postoperative lower back pain and the degree of pain after epidural delivery analgesia. DXMS pretreatment in epidural analgesia deserved to be widely used clinically.

show abstract

Section: Discussionmentioning

confidence: 99%

Local injection of dexamethasone helping to prevent lower back pain after epidural delivery analgesia

Yang

Liu

et al. 2018

Exp Ther Med

View full text Add to dashboard Cite

show abstract

“…Then, an epidural catheter was placed by needle through needle technique. The DPE technique is a modi cation of the CSEA technique, where a dural perforation is created with a spinal needle, but intrathecal medication is withheld [12]. For induction of EPI and DPE, levobupivacaine (0.125%) with fentanyl (5 μg/mL) was administered incrementally (10-20 ml).…”

Section: Standard Protocol For Labor Epidural Analgesiamentioning

confidence: 99%

Association of Chorioamnionitis With Failed Conversion of Epidural Labor Analgesia to Cesarean Delivery Anesthesia: a Retrospective Cohort Study

Katakura

Nagamine

Goto

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: This study examined the association between clinically diagnosed chorioamnionitis and failed conversion of epidural labor analgesia to cesarean delivery anesthesia.Methods: This retrospective cohort study, conducted in a single-center university hospital, enrolled term parturients undergoing emergency cesarean section after induction of epidural labor analgesia between September 2015 and May 2019. For the purpose of the study, all cases were re-examined to ensure that they fulfilled the criteria of chorioamnionitis, regardless of the actual indication for cesarean section proposed by obstetricians at the time of application. The primary outcome was failure of conversion of epidural labor analgesia to cesarean delivery anesthesia. Multivariable logistic regression analysis was performed to investigate the association between chorioamnionitis and failure of anesthesia for cesarean section.Results: Among the 180 parturients, it was found that 58 parturients (43.9%) fulfilled the criteria of chorioamnionitis. Failure of epidural conversion in the chorioamnionitis (+) group was significantly higher than that in the chorioamnionitis (-) group (46.6 % [27/58] vs. 18.9% [14/74], crude odds ratio = 3.7, 95% confidence interval 1.7-8.3). After adjustment for potential confounders (age, body mass index, multiparity, and duration for epidural labor analgesia), chorioamnionitis was found to be associated with failure of anesthesia for cesarean sections (adjusted odds ratio = 3.6, 95% confidence interval 1.6-8.4). Conclusions: Chorioamnionitis is associated with the failed conversion of epidural labor analgesia to cesarean delivery anesthesia.

show abstract

“…DPE technique may thus provide a faster onset of labour analgesia giving a better quality, reliable, and consistent block compared with the epidural technique with less maternal and foetal side effects compared with the CSE technique. [ 24 25 ]…”

Section: Dural Puncture Epidural Techniquementioning

confidence: 99%

Neuraxial techniques of labour analgesia

Gupta

Partani

2018

Indian J Anaesth

View full text Add to dashboard Cite

In recent years, many neuraxial techniques have been introduced to initiate and maintain labour analgesia, with low-dose mixtures of local anaesthetics and opioids, which have improved the quality of analgesia and made it safer for both mother and neonate. An independent search of the databases of PubMed, Medline, and Cochrane controlled trial data was conducted by two researchers, and randomized controlled trials that compared different methods of neuraxial analgesia and the different techniques of maintaining labor analgesia were retrieved and analyzed. The advantages, disadvantages, and indications of each technique along with the doses of intrathecal and epidural drugs are discussed. The myths and controversies involving neuraxial labor analgesia and the current consensus on their effect on the maternal and foetal outcomes are also outlined.

show abstract

Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques: A Randomized Clinical Trial

Abstract: Analgesia onset was most rapid with CSE with no difference between DPE and EPL techniques. The DPE technique has improved block quality over the EPL technique with fewer maternal and fetal side effects than the CSE technique for parturients requesting early labor analgesia.

Cited by 189 publications

References 31 publications

Local injection of dexamethasone helping to prevent lower back pain after epidural delivery analgesia

Local injection of dexamethasone helping to prevent lower back pain after epidural delivery analgesia

Association of Chorioamnionitis With Failed Conversion of Epidural Labor Analgesia to Cesarean Delivery Anesthesia: a Retrospective Cohort Study

Neuraxial techniques of labour analgesia

Contact Info

Product

Resources

About