Dural puncture epidural versus conventional epidural block for labor analgesia: a systematic review of randomized controlled trials

Rijs, K.; Rossaint, Rolf; Klimek, Markus

doi:10.1016/j.ijoa.2019.05.007

Cited by 49 publications

(24 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…DPE means that the operator puncture the dural with a spinal needle through the epidural needle without adding any drugs. Its unique advantages may be more appropriate for labor analgesia, though this remains controversial, and whether it is beneficial for initiating labor analgesia and the quality of analgesia has not been determined (9). CEI means Continuous epidural infusion (CEI) means continuous infusion into epidural space.…”

Section: Introductionmentioning

confidence: 99%

A randomized trial of the dural puncture epidural technique combined with programmed intermittent epidural boluses for labor analgesia

Wang¹,

Zhang²,

Zheng³

et al. 2021

Ann Palliat Med

View full text Add to dashboard Cite

Background: Continuous epidural infusion (CEI) can provide analgesia during labor. The dural puncture epidural (DPE) technique is used to accelerate the onset of neuraxia anesthesia. The primary objective of this study was to compare the percentage of patients that received adequate labor analgesia following an injection of 0.08% epidural ropivacaine via the DPE and CEI techniques combined with the PIEB mode of maintenance.Methods: Patients who were laboring were randomly allocated to receive either CEI + PIEB or DPE + PIEB. Subjects indicated a VAS score immediately prior to epidural placement, and parturients with a VAS score of ≤50 mm were excluded. A 25-gauge needle was used for dural puncture. Analgesia was provided with 10 mL of 0.08% ropivacaine and 0.4 μg/mL of sufentanil, and was maintained at 10 mL/h in both groups with the same solution. All pumps were programmed for patient-controlled epidural analgesia (PCEA) boluses of 5 mL with a 20-minute lockout. VAS measurements were collected at 2-minute intervals for up to 20 minutes after initiation of the epidural bolus. The median time to adequate analgesia was analyzed using Kaplan-Meier curves and Cox proportional hazard models.Results: Data were collected and analyzed from 200 participants (n=100 per group). Adequate analgesia at 10 minutes was higher in the DPE + PIEB group compared to the CEI + PIEB group (DPE + PIEB =58.4% vs. CEI + PIEB =41.6%; P=0.007). The DPE + PIEB group also had a shorter median time to adequate analgesia [median (95% confidence interval (CI), 8 minutes (7-9 minutes) vs. 12 minutes (10-14 minutes)] compared to the CEI + PIEB group [hazard ratio (HR) =1.488; 95% CI, 1.105-2.002; P=0.002].

show abstract

Section: Introductionmentioning

confidence: 99%

A randomized trial of the dural puncture epidural technique combined with programmed intermittent epidural boluses for labor analgesia

Wang¹,

Zhang²,

Zheng³

et al. 2021

Ann Palliat Med

View full text Add to dashboard Cite

show abstract

“…We performed a dural puncture epidural followed by a slow infusion to avoid an abrupt sympathectomy. It is postulated that this technique decreases the time of onset and improves caudal spread of analgesia compared with the epidural technique without the sympathectomy observed with the combined spinal epidural technique [16,17].…”

Section: Discussionmentioning

confidence: 99%

The Anaesthetic Management of a Parturient with an Ebstein Anomaly and Prior Bidirectional Glenn Shunt

Reddy¹,

Wavrin²,

Vue³

et al. 2021

SCR

View full text Add to dashboard Cite

Parturients with Ebstein anomaly are an anaesthetic challenge due to the spectrum of disease. Patients palliated with bidirectional Glenn shunts are susceptible to right heart dysfunction due to the physiological changes during parturition. We present a 28-year-old primigravida with Ebstein anomaly surgically managed by a bidirectional Glenn shunt. Echocardiograms showed normal right ventricular function despite reported dyspnea as the pregnancy progressed. Following a comprehensive plan developed during multidisciplinary prenatal meetings, she safely delivered. In this case report, we discuss the preoperative evaluation, management of labour and delivery, and postpartum planning of parturients with palliated Ebstein anomaly.

show abstract

“…Needle‐through‐needle is a commonly used technique in obstetric analgesia for combined spinal epidural injections 2 and dural puncture epidural injections, 3 where a spinal needle is passed through an epidural needle. The utilization of the technique allows the delivery of medication into desired areas with one single insertion of a needle through the skin.…”

Section: Discussionmentioning

confidence: 99%

Needle‐Through‐Needle Technique in Lumbar Interlaminar Epidural Steroid Injection: A Case Report

Zhang¹,

Herzig

Gritsenko

et al. 2020

Pain Practice

View full text Add to dashboard Cite

When performing lumbar epidural steroid injection on obese patients, needle placement can be challenging due to the difficulty in estimating the appropriate needle length to utilize. Often times, the standard 3.5‐inch Tuohy needle is too short to reach its target. In our case report, a needle‐through‐needle technique was attempted in a lumbar interlaminar epidural steroid injection procedure after the initial needle fell short of the epidural space. To avoid removing the initial needle and restarting the procedure using a longer needle, a 20‐gauge 6‐inch Tuohy needle was inserted into the 17‐gauge 3.5‐inch Tuohy needle, successfully reaching the epidural space. This technique can facilitate quicker needle placement by avoiding the need for restarting the procedure with a longer needle. Thus, procedural time and radiation exposure may be decreased, as may patient discomfort from repeat needle insertions.

show abstract

Dural puncture epidural versus conventional epidural block for labor analgesia: a systematic review of randomized controlled trials

Cited by 49 publications

References 8 publications

A randomized trial of the dural puncture epidural technique combined with programmed intermittent epidural boluses for labor analgesia

A randomized trial of the dural puncture epidural technique combined with programmed intermittent epidural boluses for labor analgesia

The Anaesthetic Management of a Parturient with an Ebstein Anomaly and Prior Bidirectional Glenn Shunt

Needle‐Through‐Needle Technique in Lumbar Interlaminar Epidural Steroid Injection: A Case Report

Contact Info

Product

Resources

About