Dural Puncture with a 26-Gauge Spinal Needle Affects Spread of Epidural Anesthesia

Abstract

Combined spinal and epidural anesthesia may increase the risk of epidurally administered drugs spreading into the subarachnoid space through the dural hole. We studied the effect of dural puncture with a 26-gauge needle on the spread of analgesia induced by epidural injection of local anesthetics. Forty patients were randomly assigned to control and dural puncture groups. In the dural puncture group, the dura was punctured with a 26-gauge Whitacre spinal needle at L2-3 but no drug was injected. In both groups, an 18-gauge epidural catheter was inserted 4 cm cephalad into the epidural space at L2-3 and 15 mL of 2% mepivacaine without epinephrine was injected. Analgesia was assessed by pinprick at 5, 10, 15, and 20 min after injection and at the end of surgery. The caudal spread of analgesia was significantly greater in the dural puncture group than in the control group 15 and 20 min after injection (P < 0.01), but the cranial spread of analgesia was not different between the two groups. We conclude that dural puncture (without drugs) using a 26-gauge Whitacre spinal needle before epidural injection increases caudal spread of analgesia induced by epidural local anesthetics.

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

“…The dural puncture epidural (DPE) technique is a modification of the CSE technique that was first described for use in nonobstetric surgical patients in 1996 by Suzuki et al [ 13 ] and was subsequently applied by other investigators in obstetric patients[ 14 ]. It is performed by creating a perforation in the dura mater using a spinal needle (25-27 G) through the shaft of an epidural needle[ 15 ].…”

Onset of Action of Bupivacaine Administered via Dural Puncture Epidural versus Spinal, Lumbosacral, and Sacrococcygeal Epidural Injections in Dogs: Randomised Clinical Trial

“…In the Kaplan-Meier 'survival' curve, it can be observed that at least 50% of the animals in the DPE and LS groups had no patellar tendon reflex present by the time of the first assessment at 0.5 min. This is easily explainable in the DPE group, as the technique aims for migration of the local anaesthetic through the previously created orifice in the dura mater, so the patient can benefit from the quick onset of action and longer duration [15]. However, the results cannot be so easily explained in the case of the LS group.…”

“…This technique has been increasing in popularity in human anaesthesia for the last two decades as a modification of the combined spinal-epidural anaesthesia. DPE maintains some of the advantage of spinal and epidural anaesthesia such as the rapid onset of action, long duration and profound level of analgesia minimising unwanted effects, especially haemodynamic instability and PDPH [15,16].…”

Dural Puncture Epidural during Labor: A Perspective

“…7 Bernard and Swenson in their in vitro studies demonstrated the flux of epidural drugs through spinal meninges, and it was directly proportional to the size of the dural hole. 8,9 In 1996, Suzuki et al described the first DPE in clinical practice, 10 and significant improvements and refinement in the technique have been made by researchers in the obstetric field. 11 Thus, DPE was developed as a procedure in which the dura are perforated using a spinal needle without administration of intrathecal medication.…”