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.

HERMES数据显示：院内延误越长，取栓再通率越低

1文献来源Bourcier R,Goyal M,Liebeskind DS,et al.Association of time from stroke onset to groin puncture with quality of reperfusion after mechanical thrombectomy:A meta⁃analysis of individual patient data from 7 randomized clinical trials[J].JAMA Neurol,2019,76(4):405-411.2证据水平1b。3背景在大血管闭塞(large vessel occlusion,LVO)所致急性缺血性脑卒中(acute ischemic stroke,AIS)领域中,当前学界聚焦于缩短再灌注时间、识别患者的最优影像检查以及评估最佳治疗技术方法。脑血管取栓有效再通与患者的临床结局显著相关,成功再灌注通常指改良脑梗死溶栓分级(modified thrombolysis in cerebral infarction,mTICI)评定为2b和3级血流的患者。