Dural puncture epidural versus conventional epidural block for labor analgesia: a systematic review of randomized controlled trials |
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| Affiliation: | 1. Department of Anesthesia, Kantonsspital Baden, Baden, Switzerland;2. Department of Anesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands;3. Department of Anesthesia, University Hospital RWTH Aachen, Aachen, Germany;1. Department of Women''s Anaesthesia, KK Women''s and Children''s Hospital, Singapore;2. Duke-NUS Medical School, Singapore;1. Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands;2. Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands;3. Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands;1. Columbia University Irving Medical Center, Department of Anesthesiology, New York, NY, USA;2. Carlow University, Department of Mathematics, Pittsburgh, PA, USA;1. School of Medicine, University of Queensland, QLD, Australia;2. Department of Anaesthesia, Sunshine Coast University Hospital, QLD, Australia;3. School of Medicine, University of Wollongong, NSW, Australia;4. Wollongong Hospital, NSW, Australia;5. School of Medicine, University of New South Wales, NSW, Australia;6. Intensive Care Service, Royal Prince Alfred Hospital, NSW, Australia;7. School of Medicine Sydney, University of Notre Dame Australia, NSW, Australia;8. Intensive Care Service, Royal North Shore Hospital, NSW, Australia |
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| Abstract: | IntroductionDural puncture epidural (DPE) analgesia is a modification of conventional epidural analgesia that involves the intentional puncture of the dura with a spinal needle through the needle placed in the epidural space, without a medication being injected intrathecally. There have been contradictory findings regarding better analgesia and better block quality.MethodsA systematic literature search was done to identify randomized controlled trials (RCT) comparing DPE with epidural analgesia. The risk of bias was assessed with the Cochrane tool. Risk ratio and 95% confidence intervals were calculated.ResultsFive RCTs including 581 patients were identified. One RCT on caesarean section was excluded. Single studies suggested slightly better analgesia by finding a median time to achieve sufficient analgesia of two minutes less in the DPE group, a higher number of women having a pain score <10/100 at 20 min, a reduction in the number of epidural top-ups and better sacral spread. The studies did not show a difference between DPE and epidural analgesia for catheter replacement or manipulation rates, the incidence of intravascular placement or unilateral block.ConclusionThere is a lack of clear evidence on either the benefits or the risks of the DPE technique, such that a recommendation for or against its routine use is premature. Two of the three studies showing a beneficial effect of DPE came from the same institution and replication of the findings by other groups is warranted. |
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| Keywords: | Epidural, dural puncture Analgesia, labor Randomized trial |
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