Dural puncture epidural block combined with programmed intermittent epidural boluses for labor analgesia：a randomized controlled study

Abstract

Objective To investigate the effects of the dural puncture epidural(DPE) block combined with programmed intermittent epidural boluses(PIEB) technique for labor analgesia. Methods A total of 180 primiparas delivered in the Second Affiliated Hospital of Guilin Medical College from June 2021 to January 2022 were randomly divided into routine epidural block(EPL) combined with PIEB group(EPL group), combined subarachnoid epidural lolock(CSE) with PIEB group(CSE group) and DPE combined with PIEB group(DPE group). After the epidural loading dose was administered, the conventional pulse pump with 0.075% ropivacaine and 0.4 μg/ml sufentanil mixture was respectively placed according to the grouping scheme. In EPL group and DPE group, the analgesia pump was turned on 1 hour after giving loading dose, and the pulse dose was 10 ml each time at a 1-hour interval. In CSE group, the analgesic pump was turned on 1 hour after subarachnoid injection, and the pulse dose was 10ml each time for epidural administration at a 1-hour interval. Visual analog scores(VAS) during uterine contraction were measured before labor analgesia(T0), 10 min(T1)-, 20 min(T2)-, 30 min(T3)-, 60 min(T4)-, 120 min(T5)-after epidural administration, at the full time of the uterine opening(T6) and at the time of fetal delivery(T7). The onset time of effective analgesia, the incidence of breakthrough pain(BTP) and adverse reactions during labor were recorded and compared among three groups. Results There were 59 cases in EPL group, 60 cases in CSE group and 59 cases in DPE group. The onset time of effective analgesia in DPE group and CSE group was significantly faster than that in EPL group, while that in CSE group was significantly faster than that in DPE group(P＜0.017). Compared with EPL group, the rates of patient-controlled combined spinal epidural analgesia (PCEA), requiring rescue analgesia and incomplete sacrococcygeal block, and the hourly consumption of ropivacaine in CSE group and DPE group decreased significantly(P＜0.017). At T1, VAS scores in DPE group and CSE group were significantly lower than that in EPL group(P＜0.05), and in DPE group was statistically higher than that in CSE group(P＜0.05). At T2, VAS score in CSE group was significantly lower than that in EPL group(P＜0.05), and the incidence of pruritus in EPL group and DPE group was significantly lower than that in CSE group(P＜0.017). Conclusion DPE combined with PIEB technology has a faster analgesic effect and a lower incidence of BTP compared with traditional EPL technology and can be safely and effectively used for labor analgesia.

Keywords

• dural puncture epidural block
• epidural block
• combined subarachnoid epidural block
• programmed intermittent epidural bolus technique
• labor analgesia