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

Abstract

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.

Dural Puncture Epidural with 25-G Spinal Needles versus Conventional Epidural Technique in Conjunction with PIEB for Labor Analgesia: A Randomized Trial

“…18 A recent metaanalysis demonstrated that the DPE technique with 25G spinal needle offers advantages over the EP technique. 7 These advantages include hastened onset of analgesia, decreased necessity for epidural top-ups, and a reduced occurrence of asymmetric block. 7 Larger size spinal needles (25G) were used in our study.…”

“…7 These advantages include hastened onset of analgesia, decreased necessity for epidural top-ups, and a reduced occurrence of asymmetric block. 7 Larger size spinal needles (25G) were used in our study. We observed higher percentages of adequate analgesia at 8, 12, 14, and 16 minutes after the initial epidural dose in the DPE group, along with a significant shorter median time to adequate analgesia.…”

“…2 The created dural conduit is believed to facilitate translocation of epidural medication to the subarachnoid space, thereby expediting analgesic onset and enhancing its quality. 7 However, existing data do not consistently support the clinical benefits associated with the DPE technique. 2,6,8 Programmed intermittent epidural bolus (PIEB) is a novel method for maintenance of labor analgesia that intermittently injects a preset volume of local anesthetic into the epidural space at regular intervals.…”

Pain control and neonatal outcomes in 211 women under epidural anesthesia during childbirth at high altitude in Qinghai, China

“…Only 9% of mothers can tolerate labor pain ( 9 ). Epidural anesthesia effectively relieves labor pain ( 10 , 11 ). Most studies on epidural anesthesia for labor analgesia have been conducted in areas of normal altitude, e.g., plains.…”