A Comparative Study of Onset and Quality of Labour Analgesia with Dural Puncture Epidural and Conventional Epidural...

Dural puncture epidural (DPE) is a modification of the combined spinal-epidural (CSE) technique, in which a dural puncture is performed without intrathecal drug administration prior to the epidural injection. This approach has been shown to enhance the onset and caudal spread of analgesia compared to conventional epidural techniques, without the adverse effects often associated with CSE.

This study aimed to evaluate whether the DPE technique improves the onset and quality of labour analgesia in primiparous women, compared to the conventional epidural (CE) technique.

In this prospective, double-blind, randomized controlled trial, 80 ASA II nulliparous women in labour with cervical dilation of 3 -5 cm were randomly assigned to receive either DPE or CE analgesia. Epidural space was identified using the loss-of-resistance-to-air technique, followed by administration of 15 ml of 0.125% bupivacaine with fentanyl 2.5 μg/ml. Maintenance dosing was provided hourly. The primary outcome was the proportion of women reporting a pain score of NRS 3. Secondary outcomes included time to adequate analgesia, S2 blockade, sensory and motor block assessments, analgesic consumption, haemodynamic changes, adverse effects, and maternal satisfaction.

Of 78 participants completing the study, significantly more in the DPE group achieved NRS 3 at 10 minutes (64.1% vs. 20.5%, P = 0.011). DPE resulted in faster onset, greater S2 blockade, and higher maternal satisfaction. Haemodynamic parameters remained stable, with no differences in adverse effects or labour outcomes.