Mo Xiaofei, Yu Jie, Qin Zhimin, Ma Junyi, Chen Yueyue, Chen Xi
Department of Anesthesiology, Guangzhou Medical University Affiliated Women and Children's Medical Center, Guangzhou, People's Republic of China.
Drug Des Devel Ther. 2025 May 26;19:4373-4382. doi: 10.2147/DDDT.S521681. eCollection 2025.
Research indicates that the dural puncture epidural (DPE) technique offers quicker analgesia onset compared to the conventional epidural (EP) technique. Programmed intermittent epidural bolus (PIEB) is superior to continuous epidural infusion (CEI) for maintaining labor analgesia, providing better pain relief and less motor block. Few studies have explored if combining DPE with the PIEB offers additional benefits in analgesia onset, maintenance, local anesthetic consumption, and side effects compared to DPE with EP. We hypothesized that DPE, when combined with PIEB, not only speeds up analgesia onset but also improves neuraxial analgesia maintenance over EP.
A total of 126 term nulliparous women with singleton pregnancies with a VAS pain score >50 mm and cervical dilation <5 cm were randomized to receive EP+PIEB or DPE+PIEB for labor analgesia, initiated with 15 mL of 0.0625% ropivacaine with 0.4 µg/mL of sufentanil using the EP or DPE technique (using 25-gauge Whitacre needle) technique and both maintained with the same solution for PIEB (fixed volume 10 mL, intervals 45 minutes, lockout interval 15 minutes) with labor analgesia. The primary outcome was time to achieving adequate analgesia, defined as a VAS pain score ≤30 mm. Secondary outcomes included pain scores, motor blockade, obstetric and neonatal outcomes, and satisfaction with analgesia.
Adequate analgesia was achieved faster in the DPE+PIEB group than in the EP+PIEB group (hazard ratio 2.409; 95% CI 1.670 to 3.474, <0.001). The median time (interquartile range) to VAS pain score ≤30 mm was 10 (7 to 13) minutes for the DPE+PIEB group and 15 (11 to 19) minutes for the EP+PIEB group (<0.001). No differences in any of the secondary outcomes between the two groups were observed.
DPE with PIEB accelerated onset time but did not improve maintenance of neuraxial labor analgesia over DPE with EP.
研究表明，与传统硬膜外（EP）技术相比，硬膜穿破硬膜外（DPE）技术镇痛起效更快。程序化间歇性硬膜外推注（PIEB）在维持分娩镇痛方面优于持续硬膜外输注（CEI），能提供更好的疼痛缓解且运动阻滞更少。很少有研究探讨与DPE联合EP相比，DPE联合PIEB在镇痛起效、维持、局麻药用量及副作用方面是否有额外益处。我们假设，DPE联合PIEB不仅能加快镇痛起效，而且在神经轴镇痛维持方面优于EP。
总共126名单胎足月未产妇，视觉模拟评分（VAS）疼痛评分>50 mm且宫颈扩张<5 cm，随机接受EP+PIEB或DPE+PIEB进行分娩镇痛，采用EP或DPE技术（使用25G Whitacre针），初始给予15 mL含0.4 μg/mL舒芬太尼的0.0625%罗哌卡因，并均采用相同溶液进行PIEB维持（固定容量10 mL，间隔45分钟，锁定间隔15分钟）以进行分娩镇痛。主要结局为达到充分镇痛的时间，定义为VAS疼痛评分≤30 mm。次要结局包括疼痛评分、运动阻滞、产科及新生儿结局以及镇痛满意度。
DPE+PIEB组比EP+PIEB组更快达到充分镇痛（风险比2.409；95%可信区间1.670至3.474，<0.001）。DPE+PIEB组VAS疼痛评分≤30 mm的中位时间（四分位间距）为10（7至13）分钟，EP+PIEB组为15（11至19）分钟（<0.001）。两组间任何次要结局均未观察到差异。
DPE联合PIEB加快了起效时间，但在神经轴分娩镇痛维持方面并不优于DPE联合EP。
