The Effectiveness and Safety of Dural Puncture Epidural for Aged Patients Undergoing Orthopedic Surgery: A Randomized...

The dural puncture epidural (DPE) technique is a novel approach for neuraxial anesthesia. While effective for cesarean sections and labor analgesia, its use in orthopedic surgery for elderly patients remains unexplored. This study evaluates the efficacy and safety of DPE in elderly patients undergoing orthopedic surgery.

A total of 126 elderly patients were randomly assigned to three groups: epidural block (EPL), combined spinal epidural block (CSE), and DPE. The primary outcome was the onset time of anesthesia. Secondary outcomes included maximum anesthesia level, Onset time of motor block, blood pressure, and heart rate at key points, anesthetic efficacy, and adverse reactions such as hypotension, respiratory depression, nausea and vomiting, chills, and bradycardia.

The onset time of anesthesia in the DPE group was significantly shorter than in the EPL group (17.6±4.0 min vs 19.2±3.9 min, P=0.037) but longer than in the CSE group (17.6±4.0 min vs 7.0±2.8 min, P<0.001). The Onset time of motor block was notably longer in the DPE group compared to the CSE group (20.6±3.8 min vs 9.2±3.9 min, P<0.001). At five minutes post-anesthesia, mean arterial pressure was significantly higher in the DPE group than in the CSE group (88.2±7.0 mmHg vs 84.4±7.6 mmHg, P=0.018); however, no significant difference was found between the EPL and DPE groups. Additionally, there were no significant differences among all three groups regarding hemodynamic parameters at other assessed time points, incidence of adverse reactions, or anesthetic effects.

The onset time of DPE is faster than that of EPL, its impact on the circulatory system is less than that of CSE, and it has a satisfactory anesthetic effect, which may improve the anesthesia management in elderly orthopedic surgeries.