- •Studies suggest better analgesia with the dural puncture epidural (DPE) technique.
- •We analysed studies comparing DPE and conventional epidural block for labor analgesia.
- •Five studies were identified, 2 of them coming from the same institution.
- •There is a lack of clear evidence on either the benefits or the risks of the DPE technique.
Introduction
Dural puncture epidural analgesia (DPE) is a modification of conventional epidural analgesia that involves the intentional puncture of the dura with a spinal needle through the needle placed in the epidural space, without a medication being injected intrathecally. There have been contradictory findings regarding better analgesia and a better block quality.
Methods
A systematic literature search was done to identify randomized controlled trials (RCT) comparing DPE with epidural analgesia. The risk of bias was assessed with the Cochrane tool. Risk ratio and 95% confidence intervals were calculated.
Results
Five RCTs including 581 patients were identified, five reporting on labor analgesia and one on caesarean section. Single studies suggested slightly better analgesia by finding a median time to achieve sufficient analgesia of two minutes less in the DPE group, a higher number of women having a pain score <10/100 at 20 min, a reduction in the number of epidural top-ups and better sacral spread. The studies did not show a difference between DPE and epidural analgesia for catheter replacement or manipulation rates, the incidence of intravascular placement or unilateral block.
Conclusion
There is a lack of clear evidence on either the benefits or the risks of the DPE technique, such that a recommendation for or against its routine use is premature. Two of the three studies showing a beneficial effect of DPE came from the same institution and replication of the findings by other groups is warranted.