Dural Puncture Epidural versus Standard Epidural: A Randomized Double-Blinded Comparison of Optimal Programmed...

The combined use of the dural puncture epidural (DPE) and the programmed intermittent epidural bolus (PIEB) techniques for labor analgesia provides a more rapid onset of analgesia and a drug-sparing effect. We hypothesized that by using a DPE technique for initiation of labor analgesia in the setting of PIEB, the time interval between PIEB boluses may be extended. This randomized double-blind trial compared the PIEB interval required for 90% effective analgesia (EI90) between DPE and standard epidural.

Parturients requesting labour epidural analgesia were allocated randomly to receive either a DPE technique or a standard epidural technique. The PIEB regimen consisted of 10 mL boluses of 0.10% ropivacaine containing 0.5 μg/mL sufentanil. The primary outcome was the effective or ineffective analgesia for labor analgesia. The PIEB interval for the first participant in each group was set at 60 minutes; subsequent intervals were determined using a biased-coin up-and-down sequential allocation method. Effective analgesia was defined as the absence of breakthrough pain during first labor stage. The EI90 was determined through isotonic regression analysis.

The EI90 values calculated by isotonic regression analysis for the DPE and standard epidural groups were 41.7 (95% CI, 35.0 to 52.3) minutes and 37.2 (95% CI, 33.0 to 49.7) minutes, respectively. An overlap in the 95% CIs of the two groups indicates no statistically significant clinical difference between them.

In summary, under the conditions of this study, the DPE technique did not exert a clinically meaningful effect on the optimal PIEB interval for labor analgesia.