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

Sheng-You Wang; Yan He; Hai-Juan Zhu; Bo Han

doi:10.12998/wjcc.v10.i20.6890

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

World J Clin Cases. 2022 Jul 16;10(20):6890-6899. doi: 10.12998/wjcc.v10.i20.6890.

Authors

Sheng-You Wang^{1

2}, Yan He³, Hai-Juan Zhu^{1

2}, Bo Han^{1

4}

Affiliations

¹ Department of Anesthesiology, Hefei Maternal and Child Health Care Hospital, Hefei 230001, Anhui Province, China.
² Department of Anesthesiology, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei 230001, Anhui Province, China.
³ Department of Anesthesiology, Wannan Medical College, Wuhu 241002, Anhui Province, China.
⁴ Department of Anesthesiology, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei 230001, Anhui Province, China. 454379626@qq.com.

Abstract

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.

Keywords: Anesthesia; Dural puncture epidural; Epidural; Onset time; Parturients; Repeat cesarean delivery.