Comparison of labor duration between combined spinal-epidural analgesia and dural puncture epidural analgesia: a...

Prolonged labor is associated with adverse maternal and neonatal outcomes. Combined spinal-epidural analgesia and dural puncture epidural analgesia are neuraxial analgesic techniques commonly used for labor pain relief. We aimed to compare labor duration between these two techniques.

This single-center, retrospective, observational study analyzed obstetric data of women who delivered using combined spinal-epidural or dural puncture epidural analgesia between January 2022 and November 2024. We used the inverse probability of treatment weighting method with combined spinal-epidural analgesia as the treatment group. The primary outcome was first-stage labor duration; secondary outcomes included second-stage labor duration, proportion of cesarean and instrumental deliveries, and neonatal outcomes. Time-to-event analysis was performed using the Kaplan-Meier method and Cox proportional hazards models.

Of 1087 participants, 1011 were included (combined spinal-epidural analgesia, n = 845; dural puncture epidural analgesia, n = 166). After the inverse probability of treatment weighting adjustment, participant characteristics were well-balanced. First-stage labor duration did not significantly differ between groups (weighted hazard ratio, 1.14; 95% confidence interval [CI], 0.94-1.40; p = 0.187). However, combined spinal-epidural analgesia was associated with prolonged second-stage labor duration (weighted hazard ratio, 0.79; 95% CI, 0.65-0.96; p = 0.018) and lower cesarean delivery during the first stage (weighted odds ratio, 0.36; 95% CI, 0.22-0.61; p < 0.001). Other secondary outcomes were not significantly different between the groups.

First-stage labor duration was not significantly different between the two techniques. These results may inform clinical discussions about neuraxial analgesia selection in obstetric practice.