Effects of dural puncture epidural technique on onset and duration of labor analgesia: A randomized controlled trial

Abstract

Background: In the dural puncture epidural technique (DPE), a dural hole is intentionally created, but no intrathecal drugs are administered. Our study's main objective was to compare the onset and duration of DPE analgesia with a conventional epidural (CE) when an intermittent epidural bolus dose was used. Materials and Methods: The double-blinded randomized control study was conducted on 60 parturient in active labor. Patients were randomly assigned into two groups using a computer-generated random sequence by closed envelope technique. Group CE received conventional labor epidural with 20 mL 0.1% ropivacaine and 30 μg fentanyl. In group DPE, dural puncture was performed, and 20 mL 0.1% ropivacaine and 30 μg fentanyl were given through an epidural catheter. The onset of analgesia, number of bolus doses required, and pain scores were monitored. Results: The onset of analgesia was faster in Group DPE than CE (4.40 ± 1.32 vs. 6.37 ± 2.04 min, P < 0.001). There was no significant difference in analgesia duration between the two groups (109.00 ± 26.63 vs. 104.17 ± 30.62 min, P = 0.517). The requirement of top-up doses was similar in both groups (2.47 ± 0.50 vs. 2.50 ± 0.50, P = 0.80). At 5 min, mean visual analog scores were less in DPE than CE group, and this difference was statistically significant (2.43 ± 1.25 vs. 3.97 ± 1.84, P = 0.002). Conclusion: Both techniques were effective in producing labor analgesia. However, the use of DPE technique with a 27G spinal needle produced faster onset of analgesia than CE technique when intermittent epidural boluses were used without affecting the maternal and fetal outcome.