Pažur Iva, Ožegić Ognjen, Lijović Lada, Jaić Katarina Kličan, Pešić Maja
Department of Anaesthesiology, Intensive Medicine and Pain Management, University Hospital Center Sestre Milosrdnice University, Zagreb, Croatia.
Department of Anaesthesia and Critical Care, Fra Mihovil Sučić Hospital, Livno, Bosnia and Herzegovina.
Turk J Anaesthesiol Reanim. 2023 Aug 18;51(4):304-310. doi: 10.4274/TJAR.2023.221085.
Dural puncture epidural technique is refinement of standard epidural technique. Its goal is to overcome drawbacks of standard epidural. We assessed whether dural puncture epidural technique performed by 27-gauge spinal needle would provide higher quality of labour epidural analgesia by using 10 mL epidural bolus of 0.125% bupivacaine. Additionally, the impact of dural puncture epidural on epidural analgesia onset, course of labour and occurrence of maternal side effects was examined.
We designed prospective, randomized, single-blind study. A total of 76 healthy nulliparous parturients were randomly allocated to dural puncture or standard epidural group. After identification of epidural space, spinal Whitacre needle was used for dural puncture. Intrathecal drug administration was omitted at that point. Both groups received a bolus of local anaesthetic mixture, followed by a continuous infusion of diluted local anaesthetic via epidural catheter. Pain was assessed by numeric pain rating scale. The number of top-ups and mode of delivery were recorded in both groups.
After 10 minutes, there was a statistically significant difference in numeric pain rating scale ≤3 reported (=0.028), with 97.4% subjects in dural puncture epidural group achieving adequate analgesia after 10 minutes. There was no statistically significant difference in the number of additional boluses, time to delivery, Bromage scale achieved or maternal outcomes between groups.
Dural puncture epidural technique appears to be effective in providing faster onset of epidural analgesia. However, the need for additional boluses remains unchanged. It can be safely used in obstetrics, without deleterious effect on the course of labour.
硬膜穿刺硬膜外技术是标准硬膜外技术的改进。其目的是克服标准硬膜外技术的缺点。我们评估了使用27号脊髓穿刺针进行的硬膜穿刺硬膜外技术，采用10 mL 0.125%布比卡因硬膜外推注是否能提供更高质量的分娩硬膜外镇痛。此外，还研究了硬膜穿刺硬膜外技术对硬膜外镇痛起效、产程及产妇副作用发生情况的影响。
我们设计了一项前瞻性、随机、单盲研究。总共76名健康初产妇被随机分配到硬膜穿刺组或标准硬膜外组。确定硬膜外间隙后，使用Whitacre脊髓穿刺针进行硬膜穿刺。此时不进行鞘内给药。两组均接受一次局部麻醉混合液推注，随后通过硬膜外导管持续输注稀释的局部麻醉药。采用数字疼痛评分量表评估疼痛程度。记录两组追加药物的次数和分娩方式。
10分钟后，数字疼痛评分量表≤3的情况存在统计学显著差异（P = 0.028），硬膜穿刺硬膜外组97.4%的受试者在10分钟后达到充分镇痛。两组在追加推注次数、分娩时间、达到的 Bromage 量表评分或产妇结局方面无统计学显著差异。
硬膜穿刺硬膜外技术似乎能有效使硬膜外镇痛起效更快。然而，追加推注的需求未变。它可安全用于产科，对产程无不良影响。
