SummaryBackgroundThe dural puncture epidural technique is a modification of the combined spinal‐epidural technique. Data comparing the two techniques are limited. We performed this randomised study to compare the quality of labour analgesia following initiation of analgesia with the dural puncture epidural vs. the combined spinal‐epidural technique.MethodsTerm parturients requesting labour epidural analgesia were allocated randomly to receive either dural puncture epidural or combined spinal‐epidural. Analgesia was initiated with 2 mg intrathecal bupivacaine and 10 μg fentanyl in parturients allocated to the combined spinal‐epidural group and with 20 ml ropivacaine 0.1% with 2 μg.ml‐1 fentanyl in parturients allocated to the dural puncture epidural group. Analgesia was maintained using patient‐controlled epidural analgesia with programmed intermittent epidural boluses. The primary outcome of the study was the quality of labour analgesia, which was defined by a composite of five components: asymmetric block after 30 min of initiation (difference in sensory level of more than two dermatomes); epidural top‐up interventions; catheter adjustment; catheter replacement; and failed conversion to neuraxial anaesthesia for caesarean delivery, requiring general anaesthesia or replacement of the neuraxial block.ResultsOne hundred parturients were included in the analysis (48 combined spinal‐epidural, 52 dural puncture epidural). There were no significant differences between the two groups in the primary composite outcome of quality of analgesia (33% in the combined spinal‐epidural group vs. 25% in the dural puncture epidural group), risk ratio (95%CI) 0.75 (0.40–1.39); p = 0.486. Median (IQR [range]) pain scores at 15 min were significantly lower in patients allocated to the combined spinal‐epidural group compared with the dural puncture epidural group (0 (0–1[0–8]) vs. 1 (0–4 [0–10]); p = 0.018).ConclusionsThere were no significant differences in the quality of labour analgesia following initiation of a combined spinal‐epidural compared with a dural puncture epidural technique.

中文翻译：

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脊髓硬膜外联合与硬膜穿刺硬膜外技术用于分娩镇痛：一项随机对照试验*


摘要背景硬脑膜穿刺硬膜外技术是脊髓硬膜外联合技术的改进。比较这两种技术的数据有限。我们进行了这项随机研究，以比较硬膜穿刺硬膜外麻醉与脊髓硬膜外联合技术镇痛开始后的分娩镇痛质量。方法要求分娩硬膜外镇痛的足月产妇被随机分配接受硬膜穿刺硬膜外麻醉或脊髓硬膜联合麻醉。在分配到脊髓硬膜外联合组的产妇中用 2 mg 鞘内注射布比卡因和 10 μg 芬太尼开始镇痛，在分配到硬膜穿刺硬膜外组的产妇中用 20 ml 0.1% 罗哌卡因和 2 μ g.ml-1 芬太尼开始镇痛。使用患者自控硬膜外镇痛和程序化间歇性硬膜外推注维持镇痛。该研究的主要结果是分娩镇痛的质量，它由五个成分的组合定义：开始 30 分钟后不对称阻滞（两个皮节以上的感觉水平差异）;硬膜外补充干预;导管调整;导管置换术;剖宫产转为椎管内麻醉失败，需要全身麻醉或更换椎管内阻滞。结果分析包括 100 名产妇 （48 名联合脊髓硬膜外麻醉，52 名硬脑膜穿刺硬膜外麻醉）。两组镇痛质量的主要复合结局（脊髓硬膜外联合组为 33%，硬膜穿刺硬膜外组为 25%），风险比 （95%CI） 0.75 （0.40-1.39）;p = 0.486。 与硬膜穿刺硬膜外组相比，分配到脊髓硬膜外联合组的患者在 15 分钟时的中位 （IQR [范围]）疼痛评分显着降低 （0 （0-1[0-8]） 对 1 （0-4 [0-10]）;p = 0.018）。结论与硬膜穿刺硬膜外技术相比，脊髓硬膜外联合治疗开始后分娩镇痛的质量无显著差异。