Dural Puncture Epidural Technique Research Articles

Comparison of the dural puncture epidural and the standard epidural techniques in patients having labor analgesia maintained using programmed epidural boluses: a prospective double-blinded randomized clinical trial

BackgroundThe dural puncture epidural technique has been shown in some studies to improve the onset and quality of the initiation of labor analgesia compared with the standard epidural technique. However,...

Labor Analgesia Initiation With Dural Puncture Epidural Versus Conventional Epidural Techniques: A Randomized Biased-Coin Sequential Allocation Trial to Determine the Effective Dose for 90% of Patients of Bupivacaine

(Anesth Analg. 2023. doi: 10.1213/ANE.0000000000006691) Neuraxial labor analgesia includes the conventional epidural (EPL) technique as well as the combined spinal epidural and dural puncture epidural (DPE) techniques. Some advantages to the DPE technique have been discovered through research in comparison to the EPL technique. A study was conducted using a biased-coin up-down allocation method to determine the effective dose of bupivacaine needed to achieve initial analgesia in 90% of women in labor (ED90) using the DPE and EPL techniques. It was hypothesized that a lower bupivacaine dose would be needed with the DPE versus the EPL.

Clinical effect of different concentrations of ropivacaine in the labor analgesia of dural puncture epidural technique for obese puerperae

BackgroundThis study was performed to analyze the clinical effect of different concentrations of ropivacaine in the labor analgesia of the dural puncture epidural (DPE) technique for obese puerperae.MethodsOne hundred and fifty first-term obese women who received vaginal delivery and required labor analgesia in our hospital were selected prospectively for this study, and divided into groups A, B, and C. The three groups of puerpera were given epidurals with different concentrations of ropivacaine (0.075%, 0.10%, and 0.125%) with sufentanil (0.5 μg/ml) for the labor analgesia regimen. The visual analog scale (VAS), Ramsay scale, and Bromage scale of puerperae before analgesia and at different time points after anesthesia, and analgesic onset time, analgesia time, first PCEA time, PCEA pressing time, ropivacaine consumption, labor time, maternal blood pressure and heart rate, maternal adverse reactions, blood gas analysis in the neonatal umbilical artery, and Apgar score were observed.ResultsThe analgesia onset time, PCEA pressing time, and ropivacaine consumption in group C were lower and the analgesia time and the first PCEA time were longer than those in groups A and B. At T1-T3 and T5, VAS scores of group A were higher than those in groups B and C, Ramsay score of group A was lower than that of groups B and C at T2–T3, and Bromage score of group C at any time point was higher than other two groups. The time of the second stage of labor in groups B and C was longer than that in group A, which in group C was longer than that in group B. Compared with groups A and C, the blood pressure and heart rate of puerperae in group B were closer to normal values. Three different concentrations of ropivacaine had no significant effect on the umbilical artery blood gas analysis indices and Apgar scores at 1st minute and 5th minute in neonates. The incidence of maternal adverse reactions in group C was lower than those in groups A and B.Conclusion0.1% ropivacaine combined with 0.5 μg/ml sufentanil through DPE technique has good analgesic efficacy and few adverse effects in obese puerperae.

Randomized Assessment of the Optimal Time Interval Between Programmed Intermittent Epidural Boluses When Combined With the Dural Puncture Epidural Technique for Labor Analgesia

(Anesth Analg. 2023;136:532–539) Neuraxial labor analgesia has advanced to include the dural puncture epidural (DPE) and the programmed intermittent epidural bolus (PIEB) techniques. This study aimed to test the appropriate interval for effective analgesia when the DPE technique is followed by the PIEB technique. This study used fixed volumes of PIEB at 10 mL of ropivacaine 0.1% and 0.5 mg/mL of sufentanil.

Labor Analgesia Initiation With Dural Puncture Epidural Versus Conventional Epidural Techniques: A Randomized Biased-Coin Sequential Allocation Trial to Determine the Effective Dose for 90% of Patients of Bupivacaine.

The dural puncture epidural (DPE) technique has a faster onset, better sacral spread, and improved bilateral coverage when compared to the conventional epidural (EPL) technique. Whether these qualities translate into a lower bupivacaine dose to provide initial analgesia is unknown. We sought to determine the effective dose of bupivacaine to achieve initial (first 30 minutes) labor analgesia in 90% of patients (ED90) with the DPE and EPL techniques, using a biased-coin, sequential allocation method. A total of 100 women of mixed parity with term, singleton gestation at ≤5 cm dilation with no major comorbidities were randomized to receive a DPE or an EPL technique. An experienced anesthesiologist performed these techniques and administered an allocated dose of plain bupivacaine diluted with isotonic sterile 0.9% saline to a total volume of 20 mL via the EPL catheter. Bupivacaine doses for each subject were determined by the response of the previous subject, using a biased-coin sequential allocation method, with success defined by a numeric rating scale (NRS) < 3 at 30 minutes. Outcome assessments were performed by an investigator blinded to the technique and bupivacaine dose. Sensory and motor blockade and maternal or fetal side effects were recorded every 5 minutes for the first 30 minutes. The ED90 of bupivacaine with each technique was estimated using centered isotonic regression. A total of 95 women were included in the final analysis. The ED90 of bupivacaine was estimated at 29.30 mg (90% confidence interval [CI], 28.55-31.56) with a DPE technique and 45.25 mg (90% CI, 42.80-52.03) with an EPL technique. Using a biased-coin, sequential allocation method, the DPE technique requires less bupivacaine to achieve effective initial analgesia (ED90) when compared to the EPL technique.

Знеболювання в пологах - порівняння і аналіз класичної методики епідуральної аналгезії та модифікованої з пункцією твердої мозкової оболонки

Epidural analgesia (EA), most commonly used for labor analgesia, is an effective and relatively safe technique, but may be associated with slow onset, inadequate block. The use of Dural puncture epidural (DPE) is designed to find a balance between improving the quality of analgesia and reducing the frequency of side effects. Purpose - to compare two methods of labor analgesia. Materials and methods. All women (n=80) were divided into two groups: the Group I (n=40) used DPE, the Group II (n=40) used EA. In both groups, the same technique of epidural puncture and catheterization was used, in the Group I additionally puncture of the dura mater. Analgesia was evaluated using the visual analog pain rating scale (VAS). The quality and effectiveness of analgesia, the hemodynamics of the woman were evaluated. Complications and unwanted effects were recorded. Fetal condition: cardiotocography (CTG), umbilical cord blood lactate, pH. A statistical analysis of the obtained data was carried out. Results. The first contraction (VAS1) in the Group I were fixed on 11.43.3 min, and in the Group II on 21.57.2 min (p0.05). Monolateral block in the Group I - 4 (10%) versus 10 (25%) (p0.05). Contractions (VAS 1) after 30 min in the Group II - 7 (17.5%) versus the absence of such in the Group I. Stroke volume in the Group I decreased by 2.1% versus 1.5% in the Group II. The data for hypotension and occurrence of complications, CTG, cord blood lactate, and pH were not different by group. Conclusions. The use of the DPE technique against EA gives better results in terms of the quality and effectiveness of analgesia. The mother’s hemodynamics remained stable when using DPE. The DPE technique does not increase the frequency of complications compared to EA. There was no difference between the groups when assessing the state of the fetus according to CTG data, pH indicators and umbilical cord blood lactate. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author.

Effects of dural puncture epidural technique with different drug delivery methods for labor analgesia: A randomized controlled clinical trial.

This study aimed to investigate the effect of dural puncture epidural (DPE) combined with small-dose lidocaine for labor analgesia. Parturients were randomly divided into epidural anesthesia (EA), DPE1, and DPE2 groups. In the EA group, 5 mL of 1% lidocaine was administered via conventional L2-L3 puncture catheterization; in the DPE1 group, epidural drug was administered after catheterization using the DPE technique; in the DPE2 group, epidural puncture drug was administered through the epidural puncture needle before catheterization using the DPE technique. The primary outcome was the onset time of analgesia. The secondary outcomes included the numerical rating scale (NRS) scores during uterine contraction before bolus injection of experimental dose (T0) and the second time (T1), the fifth time (T2) and the tenth time (T3) after bolus injection of experimental dose; NRS scores at the second stage of labor (T4) and during perineal suture (T5); operation time of anesthesia; puncture related complications; anesthesia related complications; delivery outcome; use of local anesthesia during vaginal suture; and Apgar score of the neonates. There were 115 women included. The onset time in the DPE2 group was markedly shorter than in the EA and DPE1 groups (P < .001). The NRS scores in the DEP2 group at T1 and T4 were significantly lower than in the EA and DEP1 groups (P < .001). The overall incidence of puncture related complications in the DEP1 and DEP2 groups was markedly higher than in the EA group (P < .05). In dural puncture epidural analgesia, when the experimental dose was injected directly through the epidural puncture needle, the onset time was shorter and the analgesic effect was better as compared to the injection of test dose after inserting the epidural catheter.

The Efficacy of Dural Puncture Epidural Performed by 27-gauge Whitacre Needle in Labour Epidural Analgesia: Randomized Single-Blinded Controlled Study.

Dural puncture epidural technique is refinement of standard epidural technique. Its goal is to overcome drawbacks of standard epidural. We assessed whether dural puncture epidural technique performed by 27-gauge spinal needle would provide higher quality of labour epidural analgesia by using 10 mL epidural bolus of 0.125% bupivacaine. Additionally, the impact of dural puncture epidural on epidural analgesia onset, course of labour and occurrence of maternal side effects was examined. We designed prospective, randomized, single-blind study. A total of 76 healthy nulliparous parturients were randomly allocated to dural puncture or standard epidural group. After identification of epidural space, spinal Whitacre needle was used for dural puncture. Intrathecal drug administration was omitted at that point. Both groups received a bolus of local anaesthetic mixture, followed by a continuous infusion of diluted local anaesthetic via epidural catheter. Pain was assessed by numeric pain rating scale. The number of top-ups and mode of delivery were recorded in both groups. After 10 minutes, there was a statistically significant difference in numeric pain rating scale ≤3 reported (P=0.028), with 97.4% subjects in dural puncture epidural group achieving adequate analgesia after 10 minutes. There was no statistically significant difference in the number of additional boluses, time to delivery, Bromage scale achieved or maternal outcomes between groups. Dural puncture epidural technique appears to be effective in providing faster onset of epidural analgesia. However, the need for additional boluses remains unchanged. It can be safely used in obstetrics, without deleterious effect on the course of labour.

Determination of the Optimal Volume of Programmed Intermittent Epidural Bolus When Combined With the Dural Puncture Epidural Technique for Labor Analgesia: A Random-Allocation Graded Dose-Response Study.

The dural puncture epidural (DPE) and the programmed intermittent epidural bolus (PIEB) techniques are recent innovations for labor analgesia. The optimal volume of PIEB during traditional epidural analgesia has been investigated previously but it is unknown whether these findings are applicable to DPE. This study aimed to determine the optimal volume of PIEB for effective labor analgesia after initiation of analgesia using DPE. Parturients requesting labor analgesia received dural puncture with a 25-gauge Whitacre spinal needle and then had analgesia initiated with 15 mL of ropivacaine 0.1% with sufentanil 0.5 μg/mL. Analgesia was maintained using the same solution delivered by PIEB with boluses given at a fixed interval of 40 minutes starting 1 hour after the completion of the initial epidural dose. Parturients were randomized to 1 of 4 PIEB volume groups: 6, 8, 10, or 12 mL. Effective analgesia was defined as no requirement for a patient-controlled or manual epidural bolus for 6 hours after the completion of the initial epidural dose or until full cervical dilation. The PIEB volumes for effective analgesia in 50% of parturients (EV50) and 90% of parturients (EV90) were determined using probit regression. The proportions of parturients with effective labor analgesia were 32%, 64%, 76%, and 96% in the 6-, 8-, 10-, and 12-mL groups, respectively. The estimated values for EV50 and EV90 were 7.1 (95% confidence interval [CI], 5.9-7.9) mL and 11.3 (95% CI, 9.9-15.2) mL, respectively. There were no differences in side effects, including hypotension, nausea and vomiting, and fetal heart rate (FHR) abnormalities among groups. Under the conditions of the study, after initiation of analgesia using DPE, the EV90 of PIEB for effective labor analgesia using ropivacaine 0.1% with sufentanil 0.5 μg/mL was approximately 11.3 mL.

Quality of Labor Analgesia With Dural Puncture Epidural Versus Standard Epidural Technique in Obese Parturients: A Double-blind Randomized Controlled Study

(Anesthesiology. 2022;136:678–687) Dural puncture epidural technique is a nested needling procedure wherein a spinal needle is passed through the epidural needle and through the dura, without the injection of intrathecal (IT) medications. Delivery of neuraxial analgesia is initiated only through the epidural catheter. Even in the absence of additional medication, dural puncture’s purported advantage over standard epidural placement is the unambiguous return of cerebrospinal fluid (CSF) through the spinal needle, confirming midline placement. Dural puncture may also facilitate the transfer of epidural drugs through the dural breach to help establish onset and quality of analgesia. Evidence for the efficacy of this approach is limited with some mixed data showing no clear clinical advantage. Obese parturients are particularly susceptible to epidural failure, and also at higher risk for emergency cesarean delivery wherein well-initiated neuraxial analgesia would be a further asset to avoid general anesthesia. The ostensible advantage of improved analgesic effect with the use of dural puncture vs standard epidural technique is investigated in obese patients who have the potential to draw strong benefit from an enhanced success rate for quality analgesia given the challenges inherent to this patient population.

Labour analgesia-epidural/combined spinal epidural/dural puncture epidural/entonox - A cafeteria choice for the patient or just research!

Labour analgesia-epidural/combined spinal epidural/dural puncture epidural/entonox - A cafeteria choice for the patient or just research!

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

BACKGROUNDRepeat 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.AIMTo determine the efficacy and safety of the DPE anesthesia technique in patients undergoing repeat cesarean delivery.METHODSPatients 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.RESULTSA 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).CONCLUSIONThe 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.

Dural puncture epidural versus conventional epidural analgesia for labor: a systematic review and meta-analysis of randomized controlled studies.

Dural puncture epidural (DPE) technique is a modification of the conventional epidural (EP) technique in that the dura is intentionally punctured with a spinal needle but without any spinal injection. This meta-analysis aimed to evaluate the benefits and risks associated with the DPE technique for labor analgesia. Randomized trials comparing DPE analgesia with EP analgesia for labor pain relief were systematically searched in the database of Medline, Embase, Cochrane Controlled Trials Register, Web of Science, and China Biology Medicine till 1st August 2021. The primary outcome was the percentage of patients with satisfactory pain relief following DPE or EP analgesia, which was defined as visual analog scale (VAS) pain scores ≤ 3/10 (or 30/100) measured 10min and 20min after initiation of labor analgesia. Totally ten trials with 1099 patients were included in this review. DPE technique increased the percentage of patients with VAS pain score ≤ 3/10 (or 30/100) both at 10min (RR 1.43; 95% CI 1.17, 1.74; p < 0.001; I2 = 0%) and 20min (RR 1.13; 95% CI 1.04, 1.22; p = 0.005; I2 = 0%) after labor analgesia. No adverse event was found with DPE analgesia. We conclude that compared with EP analgesia, DPE analgesia is beneficial for labor pain relief by shortening the time to achieve satisfactory pain control. Meanwhile, DPE analgesia is not associated with increased adverse maternal/fetal events.

This Month in Anesthesiology

This Month in Anesthesiology

Anesthesiology

The dural puncture epidural technique may improve analgesia quality by confirming midline placement and increasing intrathecal translocation of epidural medications. This would be advantageous in obese parturients with increased risk of block failure. In this issue of Anesthesiology, Tan et al. test the hypothesis that quality of labor analgesia will be improved with dural puncture epidural compared to standard epidural technique in obese parturients. In an accompanying editorial, Segal and Pan describe the evolution of the dural puncture epidural technique and conclude that the overall impact of this technique on the quality of labor analgesia is modest at best. Cover Illustration: A. Johnson, Vivo Visuals Studio.

Optimum programmed intermittent epidural bolus interval time between 8 mL boluses of Ropivacaine 0.1% with sufentanil 0.3 μg/mL with dural puncture epidural technique for labor analgesia: A biased-coin up-and-down sequential allocation trial

ObjectiveThe combination of dural puncture epidural (DPE) technique and programmed intermittent epidural bolus (PIEB) is a novel alternative labor analgesia regimen providing rapid analgesia onset and improved analgesia quality. However, the optimum PIEB settings for using the DPE technique remain unclear. DesignBiased-coin up-and-down sequential allocation design. SettingLabor analgesia. PatientsForty nulliparous women requesting labor analgesia. InterventionsDural was punctured using a 25-gauge Whitacre needle. 12 mL of 0.1% ropivacaine with 0.3 μg/mL of sufentanil was used for initiation. Labor analgesia was maintained using the same solution with a fixed 8 mL volume beginning 1 h after initiation. The interval for the first patient was 60 min and varied for subsequent patients according to the biased-coin design (groups 60, 50, 40, and 30; interval 60, 50, 40, and 30 min, respectively). MeasurementsThe primary outcome was adequate analgesia, defined as no request of patient-controlled epidural analgesia or provider boluses for 6 h after the epidural analgesia initiation or until the maternal cervix was fully dilated, whichever came first. The secondary outcomes included sensory blockade level, motor strength, maternal hypotension, and pruritus. ResultsThe estimated effective interval in 90% of participants was 41.5 min (95% CI 39.5–43.5 min) and 40.5 min (95% CI 33.7–47.5 min) by the truncated Dixon and Mood method and the isotonic regression method, respectively, for the 40 women included. The proportions of patients with the highest sensory block level achieving or above T6 were 60%, 26%, 27%, and 0% in groups 30, 40, 50, and 60, respectively. One patient presented a Bromage score of 1. There was a low incidence of hypotension in all the groups with no need for vasopressor treatment. ConclusionsThe optimum PIEB interval time between 8 mL boluses of ropivacaine 0.1% and sufentanil 0.3 μg/mL when using the DPE technique was approximately 41 min.

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

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.

Quality of Labor Analgesia with Dural Puncture Epidural versus Standard Epidural Technique in Obese Parturients: A Double-blind Randomized Controlled Study.

The dural puncture epidural technique may improve analgesia quality by confirming midline placement and increasing intrathecal translocation of epidural medications. This would be advantageous in obese parturients with increased risk of block failure. This study hypothesizes that quality of labor analgesia will be improved with dural puncture epidural compared to standard epidural technique in obese parturients. Term parturients with body mass index greater than or equal to 35 kg · m-2, cervical dilation of 2 to 7 cm, and pain score of greater than 4 (where 0 indicates no pain and 10 indicates the worst pain imaginable) were randomized to dural puncture epidural (using 25-gauge Whitacre needle) or standard epidural techniques. Analgesia was initiated with 15 ml of 0.1% ropivacaine with 2 µg · ml-1 fentanyl, followed by programed intermittent boluses (6 ml every 45 min), with patient-controlled epidural analgesia. Parturients were blinded to group allocation. The data were collected by blinded investigators every 3 min for 30 min and then every 2 h until delivery. The primary outcome was a composite of (1) asymmetrical block, (2) epidural top-ups, (3) catheter adjustments, (4) catheter replacement, and (5) failed conversion to regional anesthesia for cesarean delivery. Secondary outcomes included time to a pain score of 1 or less, sensory levels at 30 min, motor block, maximum pain score, patient-controlled epidural analgesia use, epidural medication consumption, duration of second stage of labor, delivery mode, fetal heart tones changes, Apgar scores, maternal adverse events, and satisfaction with analgesia. Of 141 parturients randomized, 66 per group were included in the analysis. There were no statistically or clinically significant differences between the dural puncture epidural and standard epidural groups in the primary composite outcome (34 of 66, 52% vs. 32 of 66, 49%; odds ratio, 1.1 [0.5 to 2.4]; P = 0.766), its individual components, or any of the secondary outcomes. A lack of differences in quality of labor analgesia between the two techniques in this study does not support routine use of the dural puncture epidural technique in obese parturients.

A pilot study comparing dural puncture epidural with 27G Whitacre needle and conventional lumbar epidural labor analgesia

BackgroundThe dural puncture epidural (DPE) technique is relatively a new technique of labor analgesia and has been advocated with the advantage of faster onset of pain relief. However, there are differences of opinion regarding the efficacy of the DPE technique and the size of the spinal needle to be used for the DPE. Various studies have suggested that DPE can only be done with a larger gauge of a spinal needle; however, recent studies have variable observations. We have compared the conventional lumbar epidural analgesia and DPE using a 27G pencil-point needle to assess the efficacy of DPE and its possible side effects.ResultsThe time to achieve a 50% reduction in VAS was 7.06 ± 0.79 min in group CLE (n = 15) and 5.0 ± 1.06 min in group DPE (n = 15) (difference of two means was 2.06, 95% CI [1.36, 2.75], t = 5.99, p < 0.0001). The time to achieve VAS < 3 in group CLE was 14.93 ± 1.98 min, and in the group DPE, it was 10.13 ± 1.45 min (difference of two means was 4.8, 95% CI [3.52, 6.09], t = 7.55, p < 0.0001). The mode of delivery, APGAR scores, and side effects were comparable (p > 0.05).ConclusionsDPE provided faster relief of labor pain than the conventional labor epidural analgesia. There were no added side effects by DPE in conventional lumbar epidural analgesia for labor. A 27G Whitacre pencil-point needle can be used for DPE.Trial registrationCTRI, CTRI/2020/08/027060. Registered on 10/08/2020. Trial registered prospectively. CTRI website URL: http://ctri.nic.in

Routine Dural Puncture Epidural Technique; Caution is in Order

Routine Dural Puncture Epidural Technique; Caution is in Order