Dural Puncture Epidural versus Standard Epidural: A Randomized Double-Blinded Comparison of Optimal Programmed Intermittent Epidural Bolus Intervals for Labor Analgesia.

BACKGROUND: The combined use of the dural puncture epidural (DPE) and the programmed intermittent epidural bolus (PIEB) techniques for labor analgesia provides a more rapid onset of analgesia and a drug-sparing effect. We hypothesized that by using a DPE technique for initiation of labor analgesia in the setting of PIEB, the time interval between PIEB boluses may be extended. This randomized double-blind trial compared the PIEB interval required for 90% effective analgesia (EI90) between DPE and standard epidural. METHODS: Parturients requesting labour epidural analgesia were allocated randomly to receive either a DPE technique or a standard epidural technique. The PIEB regimen consisted of 10 mL boluses of 0.10% ropivacaine containing 0.5 μg/mL sufentanil. The primary outcome was the effective or ineffective analgesia for labor analgesia. The PIEB interval for the first participant in each group was set at 60 minutes; subsequent intervals were determined using a biased-coin up-and-down sequential allocation method. Effective analgesia was defined as the absence of breakthrough pain during first labor stage. The EI90 was determined through isotonic regression analysis. RESULTS: The EI90 values calculated by isotonic regression analysis for the DPE and standard epidural groups were 41.7 (95% CI, 35.0 to 52.3) minutes and 37.2 (95% CI, 33.0 to 49.7) minutes, respectively. An overlap in the 95% CIs of the two groups indicates no statistically significant clinical difference between them. CONCLUSION: In summary, under the conditions of this study, the DPE technique did not exert a clinically meaningful effect on the optimal PIEB interval for labor analgesia.