Hospital Clínico Universidad de Chile, Department of Anesthesia, University of Chile, Office B222 second floor, sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile.
St Mary's Hospital, Department of Anesthesia, McGill University, 3830 Ave Lacombe, Montreal, Quebec H3T-1M5, Canada.
J Clin Anesth. 2019 Mar;53:5-10. doi: 10.1016/j.jclinane.2018.09.030. Epub 2018 Sep 28.
This systematic review aimed to summarize the evidence derived from randomized controlled trials (RCTs) comparing dural puncture epidural analgesia (DPEA) and conventional lumbar epidural analgesia (LEA) for women undergoing labor.
The MEDLINE and EMBASE databases were searched from inception to July 2018 in order to find RCTs published in the English language, which investigated DPEA in laboring women.
Six RCTs were included in the final analysis. Their collective results remain ambiguous. Dural puncture with small (i.e., 26- or 27-gauge) spinal needles seems to confer either minimal benefits or improved analgesic quality and lower pain scores in the first 10 min. Dural puncture with 25-gauge spinal needles has been reported to provide higher success rate than conventional LEA in one trial; however two other studies could only agree on the fact that DPEA results in improved sacral blockade and fewer unilateral blocks compared to LEA.
The current evidence regarding DPEA for labor analgesia remains ambiguous. Future research should investigate the optimal (spinal) needle size for dural puncture as well as factors governing transmeningeal flux of local anesthetics and opioids in the presence of a dural hole.
本系统综述旨在总结随机对照试验（RCT）的证据，这些试验比较了行硬膜外分娩镇痛的硬膜穿刺（DPEA）和传统的腰椎硬膜外镇痛（LEA）在分娩妇女中的应用。
检索 MEDLINE 和 EMBASE 数据库，从建库至 2018 年 7 月，以寻找发表在英文文献中的比较 DPEA 在分娩妇女中的应用的 RCT。
最终有 6 项 RCT 纳入了最终分析。其综合结果仍不明确。使用小口径（即 26 或 27 号）脊针进行硬膜穿刺似乎只带来了最小的益处或改善了前 10 分钟的镇痛质量和较低的疼痛评分。一项试验报道，25 号脊针的硬膜穿刺比传统的 LEA 具有更高的成功率；然而，另外两项研究只能同意这样一个事实，即与 LEA 相比，DPEA 可改善骶部阻滞和更少的单侧阻滞。
目前关于硬膜外分娩镇痛的 DPEA 的证据仍然不明确。未来的研究应该调查硬膜穿刺的最佳（脊）针大小，以及在存在硬脑膜孔的情况下，局部麻醉剂和阿片类药物经脑膜转运的相关因素。
