Dural puncture epidural technique provides better anesthesia quality in repeat cesarean delivery than epidural technique:Randomized controlled study

BACKGROUND Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys.The dural puncture epidural(DPE)technique provides faster and more effective analgesia for labor,but there is no sufficient evidence to indicate whether it is suitable for parturients undergoing repeat cesarean delivery.AIM To determine the efficacy and safety of the DPE anesthesia technique in patients undergoing repeat cesarean delivery.METHODS Patients undergoing repeat cesarean delivery were randomly divided into the DPE and epidural anesthesia(EA)groups.A 25-G spinal needle was used for dural puncture via a 19-G epidural needle.The patients in the two groups were injected with 5 mL of 2%lidocaine followed by 15 mL of a mixture of 1%lidocaine+0.5%ropivacaine as the epidural dosage.The primary outcome was the onset time of sensory block to the T6 dermatome level and the sensory and motor block degree.RESULTS A total of 115 women were included(EA:57,DPE:58).The mean time to sensory block to the T6 Level was significantly shorter in the DPE group than in the EA group(14.7 min vs 16.6 min;95%confidence interval,13.9 to 15.4 vs 15.8 to 17.4;P=0.001).The cranial sensory block level was significantly higher at 5,10,and 15 min after the initial dose in the DPE group than in the EA group(P<0.05).The sacral sensory block level was significantly higher and the modified bromage score was significantly lower in the DPE group at each time point(P<0.05).Adverse effects and neonatal outcomes were comparable between the two groups(P>0.05).CONCLUSION The DPE technique provided higher-quality anesthesia than the EA technique,with a rapid onset of surgical anesthesia,better cranial and sacral sensory block spread and a higher motor block degree,without increasing the incidence of maternal or fetal side effects in patients undergoing repeat cesarean delivery.

Preprocedure ultrasound imaging combined with palpation technique in epidural labor analgesia

BACKGROUND For parturients with paroxysmal uterine contraction pain,rapid analgesia is needed.We used preprocedure ultrasound imaging combined with the palpation technique in epidural analgesia for labor,and evaluated the usefulness of this technique in epidural labor analgesia.AIM To evaluate the usefulness of preprocedure ultrasound imaging in epidural analgesia for labor.METHODS In this prospective randomized observational study,72 parturients were assigned to two groups(combined or palpation group).The target interspace of all parturients was first identified by the palpation technique.Then in the combined group,preprocedure ultrasound imaging was used before epidural puncture.In the palpation group,only the traditional anatomical landmarks technique(palpation technique)was performed.The primary outcome was total duration of the epidural procedure(for the ultrasound group,the duration of the preprocedure ultrasound imaging was included).The secondary outcomes were the number of skin punctures,the success rate at first needle pass,the number of needle passes,the depth from the skin to epidural space,and the complications of the procedure.RESULTS Total duration of the epidural procedure was similar between the two groups(406.5±92.15 s in the combined group and 380.03±128.2 s in the palpation group;P=0.318).A significant improvement was demonstrated for epidural puncture and catheterization in the combined group.The number of needle passes was 1.14 in the combined group and 1.72 in the palpation group(P=0.001).The number of skin puncture sites was 1.20 in the combined group and 1.25 in the palpation group(P=0.398).The success rate at first needle pass was 88.89%in the combined group and 66.67%in the palpation group(P=0.045).CONCLUSION This study demonstrated that the total duration of epidural procedures with preprocedure ultrasound imaging combined with the palpation technique was not longer than the traditional anatomical landmarks technique,which were performed by six experienced anesthesiologists in parturients with normal weights undergoing labor analgesia.