(Anesth Analg. 2017;124(2):560–569) Epidural (EPL) and combined spinal epidural (CSE) are commonly used and effective labor analgesia neuraxial techniques. EPL has minimal adverse effects, but has a slow onset time and may result in insufficient sacral spread/patchy sensory blockade. In contrast, CSE has rapid onset and excellent sacral coverage but has greater risk of adverse effects. The dural puncture epidural (DPE) technique (passing a spinal needle through the EPL needle, puncturing the dura but not injecting medication into the intrathecal space) has been shown to improve caudal spread of analgesia compared with the EPL technique, without the side effects seen with CSE. In the present study, the authors determined whether or not overall analgesia characteristics and side effects would favor the DPE technique, and hypothesized that onset of labor analgesia is most rapid with CSE, followed by DPE and EPL.

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