How neuraxial labor analgesia differs by approach: dural puncture epidural as a novel option

Günaydın, Berrin; Erel, Selin

doi:10.1007/s00540-018-2564-y

Cited by 18 publications

(15 citation statements)

References 9 publications

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“…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 ].…”

Section: Introductionmentioning

confidence: 99%

“…The dural puncture creates a conduit for translocation of the local anesthetic from the epidural to the subarachnoid space, which is a unique characteristic of the DPE technique[ 13 ]. Studies have shown that compared with standard EA, DPE can provide higher-quality analgesia and lower pain scores in the first 10 min, with a lower rate of unilateral block for labor analgesia, with lower dosages of analgesic drugs, and without adverse maternal or fetal effects[ 14 , 16 - 18 ]. DPE has also been shown to result in improved anesthetic spread and better sacral blockade than EA in lower abdominal surgery[ 13 ] and in morbidly obese parturients undergoing CD[ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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

Wang¹,

He²,

Zhu³

et al. 2022

WJCC

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BACKGROUND Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys. The dural puncture epidural (DPE) technique provides faster and more effective analgesia for labor, but there is no sufficient evidence to indicate whether it is suitable for parturients undergoing repeat cesarean delivery. AIM To determine the efficacy and safety of the DPE anesthesia technique in patients undergoing repeat cesarean delivery. METHODS Patients undergoing repeat cesarean delivery were randomly divided into the DPE and epidural anesthesia (EA) groups. A 25-G spinal needle was used for dural puncture via a 19-G epidural needle. The patients in the two groups were injected with 5 mL of 2% lidocaine followed by 15 mL of a mixture of 1% lidocaine + 0.5% ropivacaine as the epidural dosage. The primary outcome was the onset time of sensory block to the T6 dermatome level and the sensory and motor block degree. RESULTS A total of 115 women were included (EA: 57, DPE: 58). The mean time to sensory block to the T6 Level was significantly shorter in the DPE group than in the EA group (14.7 min vs 16.6 min; 95% confidence interval, 13.9 to 15.4 vs 15.8 to 17.4; P = 0.001). The cranial sensory block level was significantly higher at 5, 10, and 15 min after the initial dose in the DPE group than in the EA group ( P < 0.05). The sacral sensory block level was significantly higher and the modified bromage score was significantly lower in the DPE group at each time point ( P < 0.05). Adverse effects and neonatal outcomes were comparable between the two groups ( P > 0.05). CONCLUSION The DPE technique provided higher-quality anesthesia than the EA technique, with a rapid onset of surgical anesthesia, better cranial and sacral sensory block spread and a higher motor block degree, without increasing the incidence of maternal or fetal side effects in patients undergoing repeat cesarean delivery.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Wang¹,

He²,

Zhu³

et al. 2022

WJCC

View full text Add to dashboard Cite

show abstract

“…We performed a dural puncture epidural followed by a slow infusion to avoid an abrupt sympathectomy. It is postulated that this technique decreases the time of onset and improves caudal spread of analgesia compared with the epidural technique without the sympathectomy observed with the combined spinal epidural technique [16,17].…”

Section: Discussionmentioning

confidence: 99%

The Anaesthetic Management of a Parturient with an Ebstein Anomaly and Prior Bidirectional Glenn Shunt

Reddy¹,

Wavrin²,

Vue³

et al. 2021

SCR

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Parturients with Ebstein anomaly are an anaesthetic challenge due to the spectrum of disease. Patients palliated with bidirectional Glenn shunts are susceptible to right heart dysfunction due to the physiological changes during parturition. We present a 28-year-old primigravida with Ebstein anomaly surgically managed by a bidirectional Glenn shunt. Echocardiograms showed normal right ventricular function despite reported dyspnea as the pregnancy progressed. Following a comprehensive plan developed during multidisciplinary prenatal meetings, she safely delivered. In this case report, we discuss the preoperative evaluation, management of labour and delivery, and postpartum planning of parturients with palliated Ebstein anomaly.

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“…This results in the onset of better sacral block with improved block quality with fewer maternal and fetal side effects than the other neuraxial techniques. 12 According to the physics of flow, when the radius of the dural puncture size decreases, the solution passage per unit time also decreases. A study done by Bernards et al among monkeys analyzed various sizes of dural puncture on the flux of medications, and it showed that the flux of medication had a correlation with the size of the dural puncture.…”

Section: Mechanism Of Action Of Dpe Techniquementioning

confidence: 99%

Dural Puncture Epidural during Labor: A Perspective

Ponnusamy¹,

Thilak²

2022

Annals of SBV

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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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How neuraxial labor analgesia differs by approach: dural puncture epidural as a novel option

Cited by 18 publications

References 9 publications

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

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

The Anaesthetic Management of a Parturient with an Ebstein Anomaly and Prior Bidirectional Glenn Shunt

Dural Puncture Epidural during Labor: A Perspective

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