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Dural puncture epidural versus conventional epidural analgesia for labor: a systematic review and meta-analysis of randomized controlled studies

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Abstract

Dural puncture epidural (DPE) technique is a modification of the conventional epidural (EP) technique in that the dura is intentionally punctured with a spinal needle but without any spinal injection. This meta-analysis aimed to evaluate the benefits and risks associated with the DPE technique for labor analgesia. Randomized trials comparing DPE analgesia with EP analgesia for labor pain relief were systematically searched in the database of Medline, Embase, Cochrane Controlled Trials Register, Web of Science, and China Biology Medicine till 1st August 2021. The primary outcome was the percentage of patients with satisfactory pain relief following DPE or EP analgesia, which was defined as visual analog scale (VAS) pain scores ≤ 3/10 (or 30/100) measured 10 min and 20 min after initiation of labor analgesia. Totally ten trials with 1099 patients were included in this review. DPE technique increased the percentage of patients with VAS pain score ≤ 3/10 (or 30/100) both at 10 min (RR 1.43; 95% CI 1.17, 1.74; p < 0.001; I2 = 0%) and 20 min (RR 1.13; 95% CI 1.04, 1.22; p = 0.005; I2 = 0%) after labor analgesia. No adverse event was found with DPE analgesia. We conclude that compared with EP analgesia, DPE analgesia is beneficial for labor pain relief by shortening the time to achieve satisfactory pain control. Meanwhile, DPE analgesia is not associated with increased adverse maternal/fetal events.

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Acknowledgements

The authors would like to thank Jing Wang, MD, Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China and Yujie Song, MD, Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China for generously providing unpublished data. Finally, the great help from Lei Yang M.D., Department of Anesthesiology, West China Hospital, is highly appreciated.

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  1. Haiying Yin and Xin Tong have contributed equally and should be considered as the co-first authors.

Authors and Affiliations

  1. Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, 20#, 3rd Segment, Ren Min Nan Lu, Chengdu, 610041, People’s Republic of China

    Haiying Yin, Xin Tong & Han Huang

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Correspondence to Han Huang.

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Yin, H., Tong, X. & Huang, H. Dural puncture epidural versus conventional epidural analgesia for labor: a systematic review and meta-analysis of randomized controlled studies. J Anesth 36, 413–427 (2022). https://doi.org/10.1007/s00540-022-03061-8

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