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Summary
Background
The dural puncture epidural technique (DPE) is a modification of the combined spinal epidural technique (CSE). Data comparing the two techniques are limited. We performed this randomised study to compare the quality of labour analgesia following DPE vs. CSE.
Methods
Term parturients requesting labour epidural analgesia were randomised to DPE or CSE. Analgesia was initiated with 2 mg intrathecal bupivacaine and 10 μg fentanyl in the CSE group and with 20 mL ropivacaine 0.1% with fentanyl 2 μg/mL in the DPE group. Maintenance of analgesia was with programmed intermittent epidural boluses with patient controlled epidural analgesia (PCEA). The primary outcome was block quality defined by a composite of (1) asymmetric block after 30 minutes of initiation, (2) top-up interventions, (3) catheter adjustments, (4) failed catheter requiring replacement, and (5) need for general anaesthesia or replacement of the neuraxial anaesthesia in case of caesarean delivery. Secondary outcomes included pain scores, Bromage scores, sensory levels at 15 and 30 minutes, adverse events (hypotension, nausea, pruritus, fetal heart rate changes), duration of second stage of labour, mode of delivery, local anaesthetic dose consumption, and overall satisfaction with analgesia.
Results
One hundred patients were included in the analysis. There were no significant differences between the two groups in the primary composite outcome of quality of analgesia [33% in the CSE group vs. 25% in the DPE group, risk ratio [95% CI], 0.75 (0.40, 1.39); p = 0.486] or any of the secondary outcomes except that median [IQR] pain scores at 15 minutes were significantly lower in the CSE compared to the DPE group [0 (0, 1) vs. 1 (0, 4)], p=0.018].
Conclusions
There were no significant differences in the quality of labour analgesia following initiation with a CSE compared to a DPE technique, but pain scores at 15 minutes were lower with CSE.
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