Dural puncture epidural technique provides better anesthesia quality in repeat cesarean delivery than epidural technique: Randomized controlled study

Wang, Sheng-You; He, Ya‐Ling; Zhu, Haijuan; Han, Bo

doi:10.12998/wjcc.v10.i20.6890

Cited by 3 publications

(2 citation statements)

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“…That trial also found that women in the DPE group required significantly less intraoperative analgesia supplementation (28.1% vs 12.1%). 11 These results are consistent with our findings demonstrating faster onset time and improved block quality with the DPE technique.…”

Section: Discussionsupporting

confidence: 92%

“…The use of a test dose followed by bolus administration of epidural chloroprocaine was chosen because it closely represents the clinical environment of rapid conversion of labor epidural analgesia to surgical anesthesia for emergent cesarean delivery. A recent RCT 11 compared the efficacy of de novo DPE and standard epidural for repeated scheduled cesarean and reported a 1.9-minute difference to T6 sensory level between the groups in favor of the DPE cohort. That trial also found that women in the DPE group required significantly less intraoperative analgesia supplementation (28.1% vs 12.1%).…”

Section: Discussionmentioning

confidence: 99%

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Effect of Dural-Puncture Epidural vs Standard Epidural for Epidural Extension on Onset Time of Surgical Anesthesia in Elective Cesarean Delivery

et al. 2023

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ImportanceDural-puncture epidural (DPE) and standard epidural are common modes of neuraxial labor analgesia. Little is known about conversion of DPE-initiated labor analgesia to surgical anesthesia for cesarean delivery.ObjectiveTo determine whether DPE provides a faster onset and better-quality block compared with the standard epidural technique for cesarean delivery.Design, Setting, and ParticipantsThis double-blind, randomized clinical trial was conducted between April 2019 and October 2022 at a tertiary care university hospital (University of Arkansas for Medical Sciences). Participants included women aged 18 years and older undergoing scheduled cesarean delivery with a singleton pregnancy.InterventionsParticipants were randomized to receive DPE or standard epidural in the labor and delivery room. A T10 sensory block was achieved and maintained using a low concentration of bupivacaine with fentanyl through the epidural catheter until the time of surgery. Epidural extension anesthesia was initiated in the operating room.Main Outcomes and MeasuresThe primary outcome was the time taken from chloroprocaine administration to surgical anesthesia (T6 sensory block). The secondary outcome was the quality of epidural anesthesia, as defined by a composite of the following factors: (1) failure to achieve a T10 bilateral block preoperatively in the delivery room, (2) failure to achieve a surgical block at T6 within 15 minutes of chloroprocaine administration, (3) requirement for intraoperative analgesia, (4) repeat neuraxial procedure, and (5) conversion to general anesthesia.ResultsAmong 140 women (mean [SD] age, 30.1 [5.2] years), 70 were randomized to the DPE group, and 70 were randomized to the standard epidural group. The DPE group had a faster onset time to surgical anesthesia compared with the standard epidural group (median [IQR], 422 [290-546] seconds vs 655 [437-926] seconds; median [IQR] difference, 233 [104-369] seconds). The composite rates of lower quality anesthesia were 15.7% (11 of 70 women) in the DPE group and 36.3% (24 of 66 women) in the standard epidural group (odds ratio, 0.33; 95% CI, 0.14-0.74; P = .007).Conclusions and RelevanceAnesthesia initiated following a DPE technique resulted in faster onset and improved block quality during epidural extension compared with initiation with a standard epidural technique. Further studies are needed to confirm these findings in the setting of intrapartum cesarean delivery.Trial RegistrationClinicalTrials.gov Identifier: NCT03915574

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Effect of Dural-Puncture Epidural vs Standard Epidural for Epidural Extension on Onset Time of Surgical Anesthesia in Elective Cesarean Delivery

et al. 2023

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RETRACTED: Effects of epidural dexmedetomidine on perioperative hemodynamics in patients undergoing varicose vein surgery for the lower extremities: a prospective randomized, controlled, double-blind clinical trial

Zeng

Wang

et al. 2023

Preprint

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Study objective: To investigate the effects of epidural dexmedetomidine infusion on perioperative hemodynamics in patients. Design: Randomized, interventional, blinded clinical trial. Setting: An operating room and postoperative period in university-affiliated teaching hospital. Patients: 90 patients aged 18~65 years, of ASA status I/II, posted for elective saphenous vein peeling or aspiration surgery. Interventions: Patients were randomly divided into 0.5 μg/kg dexmedetomidine combined with 0.67% ropivacaine epidural infusion group (ED group), 0.5 μg/kg dexmedetomidine intravenous infusion combined with 0.67% ropivacaine epidural infusion group (VD group), and 0.67% ropivacaine plus isovolumic saline epidural infusion group (NS group), with 30 cases in each group. Measurements: The primary outcome was the systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) at before dexmedetomidine infusion (T0), 5 min (T1), 15 min (T2), 30 min (T3), 1 h (T4), 2 h (T5), 4 h (T6), 6 h (T7), 8 h (T8) after the start of dexmedetomidine infusion. The secondary outcomes included plasma norepinephrine (NE) concentration, myocardial oxygen consumption (MVO2), the Ramsay sedation score, the Visual Analogue Scale (VAS) score, anesthetic efficiency between three groups, patient's satisfaction with postoperative anesthesia and the occurrence of adverse reactions. Main results: Compared with NS group, SBP at T3-7 and DBP at T4-5 and T7 were significantly decreased in ED group (P＜0.05 or 0.005), SBP and DBP at T1-8 were lower in VD group (P＜0.05 or 0.005). SBP and DBP at T1-2 in ED group were higher than that in VD group (P＜0.05 or 0.005). The heart rate at T3-4 and T6-7 was lower in ED group than in NS group (P＜0.05 or 0.005). Compared with VD group, the heart rate in ED group at T7 was significantly decreased (P＜0.001). The plasma NE concentration in ED and VD groups at T3-7 was dramatically decreased compared with NS group (P＜0.05 or 0.005). The plasma NE concentration in ED group was considerably increased at T3-4 and reduced at T6 compared with VD group (P＜0.005). MVO2 was lower in both ED and VD groups than in NS group (P＜0.05 or 0.005). The anesthesia efficiency was significantly enhanced in ED group compared with VD and NS groups (P＜0.05 or 0.005). Compared with NS group, the anesthesia satisfaction score was higher in ED and VD groups (P＜0.001). The incidence of dizziness in ED group and the incidence of hypotension and dizziness in VD group were higher than that in NS group (P＜0.05 or 0.005), and the occurrence of hypotension was less common in ED group than in VD group (P=0.003). Conclusion: 0.5 μg/kg dexmedetomidine epidural infusion can provide more stable perioperative hemodynamics for patients with varicose vein surgery under epidural anesthesia, with lower incidence of hypotension and significantly advanced efficiency of epidural anesthesia.

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Dural puncture epidural with 25-G spinal needles versus conventional epidural technique for labor analgesia: A systematic review of randomized controlled trials

Lin

Yang

et al. 2024

THC

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BACKGROUND: Dural mater is punctured by using a spinal needle without drugs administrated into intrathecal space directly in dural puncture epidural (DPE) analgesia. OBJECTIVE: This study aimed to summarize the evidence of benefits and risks of DPE analgesia with 25-G spinal needles for labor pain relief. METHODS: DPE analgesia with EP analgesia for labor pain relief were systematically searched. The Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus and Web of Science databases were systematically searched till 6th November 2022 to find out randomized controlled trials (RCTs) comparing DPE (using 25-G spinal needles) with conventional epidural (EP) analgesia. The risk of bias was assessed with the Cochrane tool. Risk ratio, mean difference, and 95% confidence intervals were calculated. RESULTS: Seven RCTs with 761 parturients were identified. Pool data showed that DPE technique was associated with shorter time to pain score ⩽ 3/10, higher percentage with pain score ⩽ 3/10 at 10 min and 20 min, lower incidence of epidural top-up bolus and no S2 block, higher incidence of bilateral S2 blockade at 10 min and during labor, lower incidence of epidural top-up bolus and incidence of asymmetric block. No statistical difference in side effect and parturient satisfaction between DPE and EP technique. CONCLUSION: DPE technique with 25-G spinal needles was associated with faster analgesia onset and sacral coverage, greater sacral spread, lesser requirement of epidural top-up and lower incidence of asymmetric block. DPE technique with 25-G spinal needles showed a greater benefit to parturients.

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Dural puncture epidural technique provides better anesthesia quality in repeat cesarean delivery than epidural technique: Randomized controlled study

Cited by 3 publications

References 28 publications

Effect of Dural-Puncture Epidural vs Standard Epidural for Epidural Extension on Onset Time of Surgical Anesthesia in Elective Cesarean Delivery

Effect of Dural-Puncture Epidural vs Standard Epidural for Epidural Extension on Onset Time of Surgical Anesthesia in Elective Cesarean Delivery

RETRACTED: Effects of epidural dexmedetomidine on perioperative hemodynamics in patients undergoing varicose vein surgery for the lower extremities: a prospective randomized, controlled, double-blind clinical trial

Dural puncture epidural with 25-G spinal needles versus conventional epidural technique for labor analgesia: A systematic review of randomized controlled trials

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