Dural puncture epidural analgesia is not superior to continuous labor epidural analgesia

Some anesthesiologists consider combined spinal epidural (CSE) analgesia as superior alternative to continuous labor epidural (CLE) analgesia. However, during CSE, even small doses of intrathecally administered local anesthetics with opioids induce almost instant analgesia that precludes the testing of epidural catheters as well as early appreciation of failed epidural catheters. To overcome the shortcomings of CSE analgesia, dural puncture epidural (DPE) analgesia had been devised.

The goals for the present study were to test whether DPE technique would provide superior and safer labor analgesia as compared to CLE technique.

131 ASA Class I, II and III pregnant patients who requested labor epidural analgesia consented for their participation in this prospective randomized study. Group A patients received CLE analgesia for labor pain. Group B patients received DPE analgesia for labor pain.

After exclusion of nineteen patients, final comparative data was available for 112 patients only [Group A (n = 63) versus Group B (n = 49)]. Per our analysis, the only positive aspect for DPE analgesia as compared to CLE analgesia was that patients who received DPE analgesia reported lower incidence for immediate failures of labor analgesia (P = 0.04). However, there was higher incidence of paresthesias while performing successful dural punctures (P < 0.0001). Pre-insertion epidural depth assessment with ultrasound (n = 112) correlated positively with the air-filled loss of resistance syringe technique (r = 0.88; P < 0.0001).

DPE technique did not provide superior labor analgesia as compared to CLE technique. Technically, fewer immediate failures in labor analgesia but higher incidence of paresthesias were observed with DPE technique.