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Combined use of dural puncture epidural (DPE) procedure and programmed
intermittent epidural bolus (PIEB) found to be effective in achieving faster
labor analgesia onset.
According to a study published in the Anesthesia
& Analgesia journal, the use of dural puncture epidural (DPE) had faster
onset of action as compared to the conventional
epidural (EP) procedure for neuraxial analgesia. Also, DPE along with programmed intermittent epidural bolus (PIEB) was found to be safe and
offered highest
drug-sparing effect.
This randomized controlled trial by Yujie Song and researchers was performed to study
if DPE technique plus PIEB offers added benefits for analgesia onset, local
anesthetic drug intake, and adverse effects as compared to EP or DPE
procedures with continuous epidural infusion (CEI) in nulliparous women.
Overall, 116 nulliparous women with a visual analog
scale (VAS) pain score less than 50 mm and cervical dilation less than 5 cm
were recruited for this study. These women were categorised into groups as: EP
+ CEI group (38 women); DPE + CEI group (40 women); DPE + PIEB group (38
women). A combination of 10 mL of ropivacaine 0.1% and sufentanil 0.3 µg/mL was
used as analgesia which was sustained with the same solution at 8 mL/h in the
three groups. Severe pain not modifiable by patient-controlled epidural
analgesia (PCEA) was managed via boluses of 5 mL of ropivacaine 0.125%. “Time
to adequate analgesia” was considered as the primary outcome.
As compared to the EP
+ CEI group, the patients in the DPE + CEI and DPE + PIEB groups accomplished
quicker adequate anesthesia. Least PCEA boluses and lowest ropivacaine use in
an hour was observed in DPE + PIEB group. No differences in the secondary
outcomes like labor duration, delivery mode,
Bromage scores, adverse effects, and among three groups were prevalent.
DPE + PIEB can be
used without the risk side effects (maternal or neonatal),
noted the study researchers.
Anesthesia & Analgesia
Effect of Dural Puncture Epidural Technique Combined With Programmed Intermittent Epidural Bolus on Labor Analgesia Onset and Maintenance: A Randomized Controlled Trial
Yujie Song et al.
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