Randomized Controlled Trial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2022; 10(20): 6890-6899
Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.6890
Dural puncture epidural technique provides better anesthesia quality in repeat cesarean delivery than epidural technique: Randomized controlled study
Sheng-You Wang, Yan He, Hai-Juan Zhu, Bo Han
Sheng-You Wang, Hai-Juan Zhu, Bo Han, Department of Anesthesiology, Hefei Maternal and Child Health Care Hospital, Hefei 230001, Anhui Province, China
Sheng-You Wang, Hai-Juan Zhu, Bo Han, Department of Anesthesiology, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei 230001, Anhui Province, China
Yan He, Department of Anesthesiology, Wannan Medical College, Wuhu 241002, Anhui Province, China
Author contributions: Wang SY was responsible for the study design, data collection, and manuscript drafting; He Y and Zhu HJ were responsible for data collection and analysis; Han B reviewed and revised the article; all the authors reviewed and approved the final version to be published.
Supported by the Applied Medical Research Project of Hefei Health and Family Planning Commission, No. Hwk2020yb0016.
Institutional review board statement: The study was reviewed and approved by the Institutional Ethics Committee of the Anhui Women and Child Health Care Hospital, No. YYLL2020-15-01.
Clinical trial registration statement: This study is registered prior to subject enrollment at www.chictr.org.cn. The registration identification number is ChiCTR2100050266.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo Han, MD, Chief Doctor, Department of Anaesthesiology, Anhui Maternal and Child Health Care Hospital, No. 15 Yimin Street, Hefei 230001, Anhui Province, China. 454379626@qq.com
Received: November 23, 2021
Peer-review started: November 23, 2021
First decision: January 22, 2022
Revised: February 3, 2022
Accepted: May 16, 2022
Article in press: May 16, 2022
Published online: July 16, 2022
Abstract
BACKGROUND

Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys. The dural puncture epidural (DPE) technique provides faster and more effective analgesia for labor, but there is no sufficient evidence to indicate whether it is suitable for parturients undergoing repeat cesarean delivery.

AIM

To determine the efficacy and safety of the DPE anesthesia technique in patients undergoing repeat cesarean delivery.

METHODS

Patients undergoing repeat cesarean delivery were randomly divided into the DPE and epidural anesthesia (EA) groups. A 25-G spinal needle was used for dural puncture via a 19-G epidural needle. The patients in the two groups were injected with 5 mL of 2% lidocaine followed by 15 mL of a mixture of 1% lidocaine + 0.5% ropivacaine as the epidural dosage. The primary outcome was the onset time of sensory block to the T6 dermatome level and the sensory and motor block degree.

RESULTS

A total of 115 women were included (EA: 57, DPE: 58). The mean time to sensory block to the T6 Level was significantly shorter in the DPE group than in the EA group (14.7 min vs 16.6 min; 95% confidence interval, 13.9 to 15.4 vs 15.8 to 17.4; P = 0.001). The cranial sensory block level was significantly higher at 5, 10, and 15 min after the initial dose in the DPE group than in the EA group (P < 0.05). The sacral sensory block level was significantly higher and the modified bromage score was significantly lower in the DPE group at each time point (P < 0.05). Adverse effects and neonatal outcomes were comparable between the two groups (P > 0.05).

CONCLUSION

The DPE technique provided higher-quality anesthesia than the EA technique, with a rapid onset of surgical anesthesia, better cranial and sacral sensory block spread and a higher motor block degree, without increasing the incidence of maternal or fetal side effects in patients undergoing repeat cesarean delivery.

Keywords: Parturients, Repeat cesarean delivery, Epidural, Dural puncture epidural, Anesthesia, Onset time

Core Tip: This study aimed to explore a comparatively superior anesthesia technique for repeat cesarean delivery. The dural puncture epidural (DPE) anesthesia technique with 1% lidocaine combined with 0.5% ropivacaine provided higher-quality anesthesia than the epidural anesthesia (EA) technique, with a faster onset of surgical anesthesia, better cranial and sacral sensory block spread and a higher motor block degree, without increasing the incidence of maternal or fetal side effects, in patients undergoing repeat cesarean delivery. The DPE anesthesia technique might be a preferable anesthesia scheme over the EA technique.