Epidural vs. Dural Puncture Epidural in Labor Analgesia

The maternal pain experience encompasses psychological and emotional components, highlighting the necessity for patient-centered assessment approaches. While standard epidural and combined spinal-epidural (CSE) techniques are common, they carry risks such as inadequate sacral coverage, motor block, or fetal bradycardia. The dural puncture epidural (DPE) technique aims to combine the advantages of EP and CSE while minimizing their disadvantages. By creating a dural hole, DPE facilitates the translocation of epidural medications into the subarachnoid space, aiming to accelerate the onset of analgesia and improve block quality.This single-center, historically controlled study consists of two consecutive cohorts managed before and after a change in the clinical protocol. Group 1 (retrospective control) received standard concentration epidural analgesia. Group 2 (prospective intervention) received the low-dose DPE technique. The study hypothesizes that the low-dose DPE technique provides non-inferior analgesic efficacy with significantly reduced total bupivacaine consumption and a superior side-effect profile compared to the standard high-dose EP technique. Outcomes evaluated include total bupivacaine consumption, adequate analgesia success (NRS < 4), maternal hemodynamic changes, incidence of adverse effects including paresthesia, and patient satisfaction. Note on outcome reporting: serial intrapartum measurements of maternal blood pressure, maternal heart rate and fetal heart rate were not documented on the routine anesthesia monitoring forms used during the retrospective control period. The registered secondary outcome of maternal hemodynamic and fetal heart rate variation could therefore not be compared between the two cohorts. Baseline values recorded before the procedure were available for all 100 participants and are reported as baseline characteristics, together with the incidence of hypotension and of fetal bradycardia. No registered outcome has been removed from this record.

Inclusion criteria

• American Society of Anesthesiologists (ASA) physical status I-II
• Gestational age 37-42 weeks
• Planned vaginal delivery
• Request for labor analgesia during active labor with cervical dilation ≥ 4 cm

Exclusion criteria

• Multiple gestations
• Diagnosis of preeclampsia/eclampsia
• Severe systemic disease
• Contraindications to epidural analgesia (e.g., coagulopathy, infection at the injection site)
• History of opioid dependence
• Refusal to participate in the study protocol
• Missing data in medical records for the retrospective group