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A prospective, randomized trial comparing dural puncture epidural and standard epidural techniques using programmed intermittent epidural bolus for labor analgesia
Abstract Number: S1B-2
Abstract Type: Original Research
Initiation of labor epidural analgesia via the dural puncture epidural technique (DPE) improves block quality compared to the standard epidural technique (EPL). Programmed intermittent epidural bolus (PIEB) regimes have a local anesthetic sparing effect compared to continuous epidural infusions(CEI) for maintenance of labor analgesia. Based on the incremental improvements offered by DPE and PIEB, we hypothesized that DPE+PIEB would result in a lower hourly bupivacaine consumption compared to EPL+PIEB.
Upon ethics approval and informed consent, healthy parturients in early labor (≤ 5cm cervical dilation) requesting labor analgesia were prospectively randomized 1:1 to EPL or DPE groups. Experienced anesthesiologists performed all placements using a 17G epidural needle with or without 25G Whitacre needle. Initial dosing was 16 mL of 0.1% bupivacaine + 40mcg fentanyl over 5 min. PIEB pump settings were standardized and started after the initial dose and ended upon vaginal delivery or transfer to the operating room for cesarean delivery. The primary outcome was hourly bupivacaine consumption analyzed using independent samples T-Test. Secondary outcomes included sensory block height, asymmetric sensory or motor block, manual top-up and time to first PCEA request.
To date, 126 of 150 participants have been recruited. There was no difference in mean (SD) bupivacaine consumption (mg/h) between DPE and EPL groups [11.5(3.1) vs. 11.2(3.2) p=0.55](Figure 1). There were no significant differences in secondary outcomes between groups.
We found no reduction in hourly bupivacaine consumption with DPE+PIEB compared to EPL+PIEB. While the DPE and PIEB techniques were not complementary in further sparing local anesthetic consumption, the presence of a 25G dural puncture also did not result in undesirable analgesic outcomes (i.e. high sensory block, increased motor block). These data suggest that when converting from CEI to PIEB for maintenance of labor analgesia, epidural techniques performed with dural punctures (e.g. DPE or combined spinal epidural) do not require alteration of the standardized PIEB pump settings used for EPL techniques.
1. Chau A et al. Anesth Analg 2017
2. Wong CA et al. Anesth Analg 2006