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How neuraxial labor analgesia differs by approach: dural puncture epidural as a novel option

  • Berrin Gunaydin
  • Selin Erel
Invited Review Article

Abstract

Background and aim

Neuraxial analgesia techniques are not limited to just standard epidural and CSE blocks. A novel approach called dural puncture epidural (DPE) which is a modification of CSE in terms of practice has gained popularity after its description and use in the obstetric population.  The aim of this review is to address the practice of DPE technique as a novel option by reviewing its benefits as well as side and/or adverse effects and to understand how neuraxial labor analgesia differs by approach based on the information available in the current literature

Discussion

Despite controversies and concerns, more rapid onset of analgesia, early bilateral sacral analgesia, lower incidence of asymmetric block and fewer maternal and fetal side effects are provided with DPE when compared to epidural.

Conclusion

DPE offers a favorable risk–benefit ratio for management of neuraxial analgesia as a novel option.

Keywords

Labor pain Neuraxial analgesia Dural puncture epidural Epidural Combined spinal epidural 

References

  1. 1.
    Wong CA. Epidural and spinal analgesia for labor and vaginal delivery. In: Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin Y, Mhyre J, editors. Chestnut’s obstetric anesthesia principles and practice. Philadelphia: Elsevier-Mosby; 2014. pp. 457–517.Google Scholar
  2. 2.
    Chau A, Bibbo C, Huang CC, Elterman K, Cappiello E, Robinson J, Tsen LC. Dural puncture epidural technique (DPE) improves labor analgesia quality with fewer side effects compared with epidural and CSE techniques: a randomized clinical trial. Anesth Analg. 2017;124:560–9.CrossRefGoogle Scholar
  3. 3.
    Chau A, Tsen LC. Dural puncture epidural technique: a novel method for labor analgesia. Curr Anesthesiol Rep. 2017;7:49–54.CrossRefGoogle Scholar
  4. 4.
    Leach A, Smith BG. Subarachnoid spread of epidural local anaesthetic following dural puncture. Anaesthesia. 1988;43:671–4.CrossRefGoogle Scholar
  5. 5.
    Suzuki N, Koganemaru M, Onizuka S, Takasaki M. Dural puncture with a 26-Gauge spinal needle affects spread of epidural anesthesia. Anesth Analg. 1996;82:1040–2.PubMedGoogle Scholar
  6. 6.
    Cappiello E, O’Rourke N, Segal S, Tsen LC. A randomized trial of dural puncture epidural (DPE) technique compared with standard epidural technique for labor analgesia. Anesth Analg. 2008;107:1646–51.CrossRefGoogle Scholar
  7. 7.
    Thomas JA, Pan PH, Harris LC, Owen MD, D’Angelo R. Dural puncture with 27 Gauge Whitacre spinal needle as part of a CSE technique does not improve labor epidural catheter function. Anesthesiology. 2005;103:1046–51.CrossRefGoogle Scholar
  8. 8.
    Gupta D, Srirajakalisindi A, Soskin V. Dural puncture epidural analgesia is not superior to continuous labor epidural analgesia. MEJ Anesth. 2013;22(3):309–16.Google Scholar
  9. 9.
    Yadav P, Kumari I, Narang A, Baser N, Bedi V, Dindor BK. Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida. J Obstet Anaesth Crit Care. 2018;8(1):24–8.CrossRefGoogle Scholar
  10. 10.
    Wilson SH, Wolf BJ, Bingham K, Scotland QS, Fox JM, Woltz EM, Hebbar L. Labor analgesia onset with dural puncture epidural versus traditional epidural using a 26-Gauge Whitacre needle and 0.125% bupivacaine bolus: a randomized clinical trial. Anesth Analg. 2018;126(2):545–51.CrossRefGoogle Scholar
  11. 11.
    Bernard CM, Kopacz DJ, Michel MZ. Effect of needle puncture on morphine and lidocaine flux through the spinal meninges of the monkey in vitro. Anesthesiology. 1994;80:853–8.CrossRefGoogle Scholar
  12. 12.
    Telford RJ, Hollway TE. Observation on deliberate dural puncture with a Tuohy needle: pressure measurements. Anaesthesia. 1991;46:725–7.CrossRefGoogle Scholar
  13. 13.
  14. 14.
    Erel S, Gunaydin B. Neuraxial analgesia for labor: standard techniques versus novel approach (in Turkish with English abstract). Anestezi Dergisi (JARSS). 2017;25(3):113–6.Google Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and ReanimationGazi University School of MedicineAnkaraTurkey

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