Abstract No. : ABS0549: Comparison of dural puncture epidural technique with combined spinal epidural Technique for labour analgesia. A prospective randomised study.

Abstract

Background & Aims:The Dural puncture epidural technique (DPE) is where the dura is punctured but no intrathecal drug is given. thus avoiding potential side effects of intrathecal drugs. The goal of our study was to find whether DPE technique provides safe and better quality of analgesia compared to CSE.Methods:60 parturients of American Society of Anesthesiologists ( ASA) grade ll were divided into two groups. In DPE group, dura was punctured with spinal needle followed by insertion of epidural catheter. A test dose of 3ml of 2% lignocaine with adrenaline was given followed by 5ml of 0.125% bupivacaine. In CSE group, 1.25mg of 0.25% plain bupivacaine with 20µg fentanyl wasgiven in subarachnoid space and epidural catheter was threaded Background infusions were given in both the groups.Results:The onset time of analgesia was 460.67+/-72.96 seconds (7.67 min.) in DPE. While with CSE it was223.33+/-50 seconds (3.8 min). The time for the 1st top up, was 135.23± 22.05 minutes in group DPE and 135.67 ± 13.19 minutes in group CSE. The mean duration of labour was 245.87 ± 31.18 minutes in Group DPE and 238.23 ± 34.03 minutes in CSE group (p =0.369). The maternal haemodynamic changes were similar in both study groups. In group DPE, 80% (24) patients had normal vaginal delivery 3 (10%) underwent lower segment caesarean section (LSCS), 3 (10%) had instrumental delivery. In group CSE 73.3% (22) patients had normal vaginal delivery while 13 % (4) each underwent LSCS and instrumental forceps delivery (p=0.83). There was no significant difference in motor block between the two groups( p values greater than 0.05). Eight patients (26.7%) reported pruritus in CSE group while none in the group DPE (p = 0.005). Seven patients reported nausea in group CSE against one in group DPE (p =0.05).Foetal bradycardia was more in CSE(6) compared to DPE(1)( p=0.10). APGAR score was more than 7 in both groups.Conclusion:The quality of analgesia was good with both DPE and CSE, though onset of analgesia was slightly faster in CSE group. The maternal and foetal outcomes were better with DPE group.