Dural Puncture Epidural Technique: a Novel Method for Labor Analgesia

Abstract

In recent years, the dural puncture epidural (DPE) technique has emerged as a novel method of labor analgesia. The DPE technique involves the technical elements of a combined spinal epidural (CSE) technique but avoids the direct administration of intrathecal medications. The underlying mechanism responsible for the unique blockade qualities of the DPE technique is believed to be the translocation of medications from the epidural space into the dural sac; laboratory studies have found a positive correlation between translocation flux and the size of dural perforation. Clinically, earlier and greater sacral spread and dermatomal block symmetry have been observed in obstetric and surgical patients receiving the DPE technique compared to the epidural (EPL) technique. Moreover, the DPE technique appears to have fewer side effects than the CSE technique. The DPE technique appears to offer a paradigm shift in obstetric analgesia and anesthesia, but further investigation is warranted.