Abstract

Context: Labor is one of the most painful experiences a woman may face during her lifetime. Labor pain is excruciating and a significant contributor of stress and anxiety. Epidural analgesia is the most effective method of intra-partum pain relief and provides excellent safety profile for both the mother and the foetus. The present study was designed to compare the dural puncture epidural technique and the standard epidural technique for labor analgesia. Aims: To compare dural puncture epidural technique for labor analgesia with conventional epidural technique. The primary outcome measures were onset of analgesia and patient satisfaction; secondary outcome measures being duration of analgesia, number of top-ups required, APGAR score, side effects. Settings and Design: A prospective randomized double-blind trial was conducted at Dr. Bheem Rao Ambedkar Memorial Hospital, Raipur on 50 uncomplicated term primigravida in active labor. Methods and Material: Double-blind randomization to the dural puncture epidural group and standard epidural group was accomplished by means of Toss method. The procedure was carried out by one anesthesiologist while the observations were done by the second one who was not present at the time of the procedure. Statistical analysis: The statistical analysis was carried out using Statics Kingdom Calculator in stat software and Medcalc’s statistical calculator. Results: The mean VAS at 15 minutes was 1.32±0.48 and 1.76±0.44 in group DPE and group E respectively (p < 0.0001). The mean time of onset of analgesia was significantly earlier in group DPE (16.76 ± 1.39 vs 18.56±1.47 minutes). The mean duration of analgesia was significantly prolonged in group DPE (81.04 ± 4.69 vs 78.32±3.94 minutes) (p = 0.03). The mean number of top-ups of local anaesthetic was significantly lesser in group DPE (1.64 ± 0.49) than in group E (1.96 ±0.2) p < 0.0001). There was no incidence of nausea, vomiting, pruritus, hypersensitivity, shivering, respiratory depression or urine retention in any group. The patient satisfaction score in group DPE was excellent in 80% and good in 20% while in group E it was excellent only in 32%, good in 60% and fair in 8% patients. Conclusions: The dural puncture epidural technique has a rapid onset and prolonged duration of analgesia as compared to conventional epidural technique without any significant maternal or neonatal adverse effects.

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