Application Of Dural Puncture Epidural Technique For Labor Analgesia

Objective This study aims to evaluate the analgesia onset,block quality and side effects of dural puncture epidural technique for labor analgesia.Methods Six hundreds and sixty two American Society of Anesthesiologists(ASA)Ⅰ or Ⅱ primiparas with singleton,vertex presentation fetuses at38 to 42 weeks’ gestation with spontaneous parturiton were selected.All patients were randomly divided into 3 groups: combined spinal epidural group(group CSE),dural puncture epidural(group DPE)and epidural group(group EP).In the first 20 min,Numeric Rating Scale(NRS)score was recorded every 2 min to determine the time to reach NRS≤1,and this was the main outcome.Secondary outcomes included the occurrence of bilateral sensory block plane to the tenth thoracical(T10)or the second sacral(S2),incidence of asymmetric block,anesthesiologist supplementary intervention,catheter replacement,cesarean section or instrumental delivery,the incidence of Bromage score≥1,fetal bradycardia,excessive uterine contractions,maternal hypotension,nausea,itching,headache,nerve injury,the incidence of Apgar score less than 7 at 1 min and 5 min,the numerical rating scale(NRS2)when the uterine neck whole opened,time of the first and second stage of labor.Results Compared with group CSE,the time reached NRS≤1 was longer(P<0.05)and the incidence of anesthesiologist intervention was reduced in group DPE(P<0.05);the time reached NRS≤1 was longer(P<0.05),bilateral sensory block to S2,asymmetric block and NRS2 score increased in group EP(P<0.05).Compared with group EP,the time reached NRS≤1 was shorter(P<0.05),and the incidence of bilateral sensory block to S2,asymmetric block,anesthesiologist intervention,and NRS2 score decreased in group DPE(P<0.05).Compared with group CSE,Bromage score≥1,fetal bradycardia,excessive uterine contraction,hypotension,and itching in group DPE and EP was reduced(P<0.05).Additionally,there was no significant difference in other indexes(P>0.05).Conclusions Dural puncture epidural technique has rapid analgesia,excellent analgesic effect and low incidence of side effects.