The Effect Of Dural Puncture Epidural For Labor Analgesia

Objective:To evaluate the advantages and outcome of maternal and fetal about dural puncture epidural for labor analgesia.Provide a promotion for traditional epidural anlgesia.To present a novel technique for labor analgesia.Methods:A total of 120 qualified nulliparous parturients from our hospital were randomly assigned to epidural(EP)group,Dural punctural epidural(DPE)group and combined spinal epidural(CSE)group,A 25-gauge needle was used for dural puncture,Group CSE were adminstrated with 3ml 0.1% ropivacaine and 20μg/ml hydromorphone before place the epidural catheter.Analgesia was induced with 8ml 0.1% ropivacaine and 20μg/ml hydromorphone,and maintained with the same solution at 8 m L/h in all groups.A 8-m L patient-controlled epidural analgesia(PCEA)bolus was programmed with a 20-minute lockout.Pain was assessed by VAS(Visual analogue score;VAS)at :before analgesia(T0),10 min(T1),20 min(T2),30 min(T3),1h(T4),3h(T5).During the analgesia :the duration of the first and second stage,time of the first PCA,total PCA times,consumption of ropivacaine,fetal heart rate(FHR),neonatal Apgar score,progress of laor and maternal side effects were recored.Results:1.There were no significant difference in general condition of the three group.2.Compared with the EP,the VAS scores in all time point,PCA times,consumption of ropivacaine were obviously decreased in the DPE and CSE(P <0.05).3.Compared with the CSE group,the onset time of DPE grooup and EP group were longer(P<0.05),but on difference with the DPE and EP.4.There was no significantly difference of hypotension,percentage of Caesarean,low FHR among the three groups(P>0.05).And the incidence of pruritus and nausea and vomiting were significantly increased in CSE group and higher than the group EP and DPE(P<0.05).Conclusion:Compared with the combined spinal epidural,the dural puncture epidural technique for labor analgesia present lower occurence of relevent side effect.The dural puncture epidural has improved the block quality over the traditional epidual,which was a novel choice for labor analgesia.