Application of dural puncture epidural technique combined with programmed intermittent epidural bolus mode in labor analgesia: A randomized clinical trial

BACKGROUND: This study aims to evaluate the onset, maintenance, side effects s and the effect on newborns of dural puncture epidural (DPE) technique combined with programmed intermittent epidural bolus (PIEB) mode for labor analgesia as compared to conventional epidural (EP) technique combined with continuous epidural infusion (CEI) mode. METHODS: All patients were randomly assigned to receive EP + CEI (Group EC), EP + PIEB (Group EP), DPE + CEI (Group DC) and DPE + PIEB (Group DP). Record the time to reach Numerical Rating Scale (NRS) ≤ 1, ropivacaine consumption, the NRS when the uterine neck whole opened (NRS2), the incidence of bilateral sensory block level to S2, asymmetric block, incomplete analgesia, replacement of catheter, intrapartum fever, as well as the occurrence of neonatal Apgar score ≤ 7 at 1 minute and 5 minutes. RESULTS: A total of 455 women were included (111 in Group EC, 116 in Group EP, 114 in Group DC and 114 in Group DP). The time to reach NRS ≤ 1 in Group DP and Group DC was shorter than that in Group EP and Group EC (P < .05); the consumption of ropivacaine in Group DP was less than that in 3 other groups (P < .05); the incidence of incomplete analgesia and intrapartum fever in Group DP was lower than that in other 3 groups (P < .05). CONCLUSIONS: DPE technique can provide faster analgesia than conventional EP technique, combined with PIEB mode maybe superior to traditional methods as a labor analgesia regimen.