Comparison of dural puncture epidural approach versus conventional epidural approach for anesthesia in patients undergoing total knee arthroplasty: Prospective randomized study

Abstract

Background: Epidural anesthesia reduces the exposure to other anesthetics and analgesics. The dural puncture epidural (DPE) approach improves caudal spread of analgesia compared with epidural (EPL) approach without the side effects observed with the combined spinal EPL method. The goal of this work was to evaluate the efficacy of DPE method versus standard EPL method as an anesthetic method in cases undergoing Total Knee Arthroplasty (TKA). Methods: This prospective randomized double blinded study was carried out on 70 cases admitted for elective total knee replacement surgery. Cases were subdivided in to two equal groups: group I (EP): received fifeteen millilitres of (0.25% plain bupivacaine and 50 µg fentanyl) over 5 min., there was no dural puncture in this group and group II (DPE): who received fifeteen millilitres of (0.25% plain bupivacaine and 50 µg fentanyl) over 5 min., administered in the epidural space by epidural catheter at L3-L4 interspace, a dural puncture was created. All cases were assessed for time of onset of motor block, duration, number of top-up doses for 24 hours postoperative and adverse events. Results: There was significant decrease in mean value of time till sensory block and time till motor block occurred in group II versus group I (p value <0.001). there was significant decrease in mean value of Breen Modified Bromage scale in group II (p value <0.05) at 5min and 8min versus group I. Intergroup comparison of duration from administration of block till first top up dose and number of top up doses revealed no difference between two approaches. Conclusions: DPE method seemed to have faster onset of sensory and motor block versus standard EPL method.