Department of Anesthesiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China.
Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China.
Technol Health Care. 2024;32(2):495-510. doi: 10.3233/THC-230059.
Dural mater is punctured by using a spinal needle without drugs administrated into intrathecal space directly in dural puncture epidural (DPE) analgesia.
This study aimed to summarize the evidence of benefits and risks of DPE analgesia with 25-G spinal needles for labor pain relief.
DPE analgesia with EP analgesia for labor pain relief were systematically searched. The Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus and Web of Science databases were systematically searched till 6th November 2022 to find out randomized controlled trials (RCTs) comparing DPE (using 25-G spinal needles) with conventional epidural (EP) analgesia. The risk of bias was assessed with the Cochrane tool. Risk ratio, mean difference, and 95% confidence intervals were calculated.
Seven RCTs with 761 parturients were identified. Pool data showed that DPE technique was associated with shorter time to pain score ⩽ 3/10, higher percentage with pain score ⩽ 3/10 at 10 min and 20 min, lower incidence of epidural top-up bolus and no S2 block, higher incidence of bilateral S2 blockade at 10 min and during labor, lower incidence of epidural top-up bolus and incidence of asymmetric block. No statistical difference in side effect and parturient satisfaction between DPE and EP technique.
DPE technique with 25-G spinal needles was associated with faster analgesia onset and sacral coverage, greater sacral spread, lesser requirement of epidural top-up and lower incidence of asymmetric block. DPE technique with 25-G spinal needles showed a greater benefit to parturients.
在硬脊膜穿刺硬膜外（DPE）镇痛中，直接将药物注入硬脊膜外腔，不使用脊髓针穿刺硬脊膜。
本研究旨在总结 25-G 脊髓针用于分娩镇痛的 DPE 镇痛的益处和风险证据。
系统检索 DPE 镇痛与 EP 镇痛用于分娩镇痛的研究。系统检索 Embase、MEDLINE、Cochrane 对照试验中心注册库、Scopus 和 Web of Science 数据库，以查找比较 DPE（使用 25-G 脊髓针）与传统硬膜外（EP）镇痛的随机对照试验（RCT）。使用 Cochrane 工具评估偏倚风险。计算风险比、均数差和 95%置信区间。
共纳入 7 项 RCT，涉及 761 名产妇。汇总数据显示，DPE 技术与疼痛评分 ⩽3/10 的时间更短、10 min 和 20 min 时疼痛评分 ⩽3/10 的比例更高、硬膜外追加推注的发生率更低且无 S2 阻滞、10 min 时双侧 S2 阻滞的发生率更高且在分娩期间、硬膜外追加推注的发生率更低以及不对称阻滞的发生率更低。DPE 技术与 EP 技术在副作用和产妇满意度方面无统计学差异。
25-G 脊髓针 DPE 技术与更快的镇痛起效和骶骨覆盖、更大的骶骨扩散、对硬膜外追加推注的需求减少以及不对称阻滞的发生率降低有关。25-G 脊髓针 DPE 技术对产妇有更大的益处。
