Epidural volume extension versus dural puncture epidural analgesia for labor: A prospective randomized study

Providing effective labor analgesia is very important for maternal and infant safety. Various neuraxial techniques are used for this purpose. Our objective was to compare the epidural volume extension (EVE) and dural puncture epidural (DPE) procedures employed in clinical practice for labor analgesia, focusing on labor parameters, pain levels, fetal outcomes, and complications.

Sixty patients were randomized to EVE (n = 30) and DPE (n = 30). In the EVE group, 1 mL of a mixture containing a combination of 10 µg fentanyl and 0.25% isobaric bupivacaine was injected into the intrathecal region via a 25-G 120 mm Whitacre spinal needle. Then, 7.4 mL of 0.9% NaCl was injected into the epidural area. In the DPE group, after dural puncture with the same procedure, 20 mL of a mixture containing a combination of 2 µg/mL fentanyl and 0.125% isobaric bupivacaine was injected into the epidural area. Time of required the first top-up dose, numerical pain rating scale ≤ 1 and bilateral S2 block time, sensory block level, number of top-up doses required during labor, incidence of complications were recorded.

A total of 60 patients were analyzed. First top-up time-the primary outcome of the study, was similar between groups (76.45 ± 17.38 vs 88.20 ± 31.38, P = .067). Time to reach minimum pain score, numerical pain rating scale ≤ 1, bilateral S2 block time was significantly shorter in group EVE compared to group DPE. There was no statistical significance in terms of peak dermatome level and total number of administered top-ups, time to reach peak dermatome, incidence of complications.

While the EVE technique necessitates a reduced total volume of local anesthetic, it results in a more rapid ascent of the dermatomal level and a quicker reduction in pain scores; we believe that both strategies can be utilized effectively and safely for labor analgesia. However, randomized comparative studies with larger sample sizes are required to find the optimal strategy.