DR MANOJ A,DR BHARATHI B,DR LAKSHMI R
DOI: https://doi.org/Background: Effective labor analgesia is vital for ensuring maternal comfort and safety. While conventional epidural (CE) analgesia remains widely used, the dural puncture epidural (DPE) technique has been proposed to enhance analgesic onset without the risks associated with combined spinal-epidural (CSE) techniques. This study aims to compare DPE and CE techniques in terms of onset and duration of effective analgesia, motor block, hemodynamic stability, patient satisfaction, and neonatal outcomes.
Methods: A prospective, randomized controlled trial was conducted on 100 laboring women aged 18–40 years with singleton pregnancies at term and requesting neuraxial labor analgesia. Participants were randomly assigned to two groups (n=50 each): Group CE received standard epidural, and Group DPE received a dural puncture with a 25G spinal needle prior to epidural catheter placement. All patients received 10 ml of 0.25% ropivacaine bolus followed by Programmed Intermittent Epidural Bolus (PIEB) maintenance. Primary outcome was the time to effective analgesia (VAS ≤3). Secondary outcomes included duration of analgesia, motor block (modified Bromage scale), maternal hemodynamics, VAS scores at various intervals, satisfaction (Likert scale), and neonatal Apgar scores.
Results: The mean time to effective analgesia was significantly faster in Group DPE (10.00 ± 3.81 min) compared to Group CE (12.33 ± 3.40 min; p<0.05). Duration of effective analgesia was slightly longer in Group DPE (100.37 ± 23.18 min) compared to CE (99.77 ± 24.96 min), but this was not statistically significant. VAS scores at 5, 10, and 15 minutes were lower in the DPE group. No significant differences were found in the need for top-ups, motor block, hemodynamic parameters, or neonatal outcomes. Patient satisfaction was marginally higher in the DPE group.
Conclusion: DPE provides a faster onset of effective analgesia than CE without increasing adverse outcomes. These findings support the use of DPE as a valuable alternative for labor analgesia.
