Dural puncture epidural technique with 23-, 25- or 27-gauge pencil point spinal needles versus standard epidural...

Dural puncture epidural (DPE) improves labor analgesia by reducing numeric rating scale (NRS) score, accelerating onset, and enhancing sacral blockade. Although larger-gauge needles may potentiate local anesthetic diffusion and improve analgesic quality, current clinical practice favors smaller-gauge needles (25-gauge to 27-gauge) to mitigate post-dural puncture headache (PDPH) risks. This randomized trial specifically evaluates the differential impacts of 23-gauge, 25-gauge, and 27-gauge needles on both analgesic efficacy and procedure-related complications.

In this randomized trial, 200 parturients requesting labor analgesia received DPE (23-gauge, 25-gauge, 27-gauge subgroups) or standard epidural (EP), followed by programmed intermittent epidural boluses (PIEB) of 12 mL with ropivacaine 0.08% and sufentanil 0.33 µg/mL every 50 min. Primary outcome was NRS score 10 min after the initial epidural bolus; secondary outcomes included time to NRS score ≤ 1, block characteristics at 20 min, number of top-up boluses, Apgar scores, and adverse events.

Among 198 analyzed participants, all DPE groups exhibited lower 10-minute NRS scores versus EP groups (P < 0.001). The 23-gauge and 25-gauge subgroups had lower NRS scores than 27-gauge (P < 0.05), with no difference between 23-gauge and 25-gauge (P > 0.05). The 23-gauge group achieved NRS score ≤ 1 fastest (P < 0.001). DPE groups demonstrated higher bilateral sacral (S2) blockade rates versus EP groups (P < 0.001), with no inter-subgroup differences. No significant difference were observed in procedure duration, top-up requirements, catheter adjustments/replacement, complications (PDPH, hypotension, nausea), or neonatal Apgar scores at 1 and 5 min.

Compared to conventional epidural analgesia, the combined application of DPE and PIEB techniques demonstrated superior quality. The utilization of 25-gauge pencil-point spinal needles achieves the optimal balance between analgesic efficacy and safety, while the 23-gauge needle may be suitable for specific scenarios requiring rapid onset of action.