Dural puncture epidural technique provides better anesthesia quality in repeat cesarean delivery than epidural technique: Randomized controlled study

Table 1 Demographic data in the two groups

	EA (n = 57)	DPE (n = 58)	Z/t/χ2	95%CI of difference	P value
Age (yr)	28.0 (26.0-30.0)	28.0 (25.0-30.0)	0.766	-1.0, 1.0	0.4432
Height (cm)	159.7 ± 3.8	160.6 ± 4.2	1.159	-2.4, 0.6	0.2491
Weight (kg)	73.0 (69.5-75.0)	73.5 (71.8-76.0)	1.622	-3.3, 0.2	0.1052
BMI (kg/m2)	28.2 ± 1.9	28.5 ± 1.7	0.981	-1.0, 0.3	0.3292
Gestational age (w)	39.8 ± 1.1	39.5 ± 1.1	1.450	-0.1, 0.7	0.1501
Hb (g/l)	116.7 ± 8.5	117.0 ± 8.3	0.223	-3.5, 2.8	0.8241
HCT (%)	35.4 ± 2.3	35.0 ± 2.2	0.782	-0.5, 1.2	0.4361
ASA physical status
Class 1	6 (10.5)	10 (17.2)	1.082	0.1, 1.7	0.2983
Class 2	51 (89.5)	48 (82.8)

¹Student’s t test.

²Mann-Whitney U test.

³Chi-square test.

Values are expressed as n (%), mean ± SD, or median (interquartile range). P < 0.05 is present to be significant. ASA: American Society of Anesthesiologists; BMI: Body mass index; Hb: Hemoglobin; HCT: Hematocrit; CI: Confidence interval; DPE: Dural puncture epidural; EA: Epidural anesthesia.

Table 2 Details of anesthesia, adverse effects, and neonatal outcomes

	EA (n = 57)	DPE (n = 58)	Z/t/χ2	95%CI of difference	P value
The onset time to T6 level (min)	16.6 (15.8-17.4)	14.7 (13.9-15.4)	4.039	-5.0, 0.0	0.0012
Maximum sensory level (T)	5 (4-6)	5 (4-5)	1.120	0.0, 1.0	0.2632
Modified bromage score to 3, n (%)	21 (36.8)	45 (77.6)	19.516	2.6, 13.5	< 0.001
Cranial sensory block to T6, n (%)	30 (52.6)	54 (93.1)	23.915	3.8, 38.0	< 0.001
Vasopressor administration, n (%)	6 (10.5)	9 (15.5)	0.631	0.5, 4.7	0.4273
Intraoperative IV analgesic supplementation, n (%)	16 (28.1)	7 (12.1)	4.600	0.1, 0.9	0.0323
Local anesthetic volume (ml)	20.0 (17.5-20.0)	20.0 (15.0-20.0)	0.429	0.0, 0.0	0.6682
Fluid administration (ml)	800.0 (750.0-800.0)	800.0 (700.0-800.0)	0.806	0.0, 0.0	0.4242
Estimated blood loss (ml)	400.0 (400.0-400.0)	400.0 (300.0-400.0)	1.548	0.0, 0.0	0.1222
Duration of surgery (min)	37.4 ± 8.3	36.3 ± 6.3	0.746	-3.7, 1.7	0.4571
Urine output (ml)	100.0 (100.0-150.0)	100.0 (100.0-150.0)	0.248	0.0, 0.0	0.8042
Adverse effects, n (%)
Hypotension	5 (8.8)	2 (3.5)	1.425	0.1, 2.0	0.4223
Respiratory depression	0 (0.0)	0 (0.0)	0.000	0.0, 0.0	1.0003
Postdural headache	0 (0.0)	0 (0.0)	0.000	0.0, 0.0	1.0003
Nausea and vomiting	7 (12.3)	5 (8.6)	0.412	0.2, 2.3	0.5213
Chest distress	5 (8.8)	7 (12.1)	0.334	0.4, 4.8	0.5633
Dizzy	6 (10.5)	4 (6.9)	0.477	0.2, 2.4	0.7193
Nasal obstruction	5 (8.8)	6 (10.3)	0.082	0.3, 4.2	0.7743
Chills	19 (33.3)	14 (24.1)	1.188	0.3, 1.4	0.2763
Neonatal outcomes
Apgar score < 8 at 1 min, n (%)	3 (5.3)	2 (3.4)	0.000	0.1, 4.0	0.9843
Apgar score < 8 at 5 min, n (%)	0 (0.0)	0 (0.0)	0.000	0.0, 0.0	1.000

¹Student’s t test.

²Mann-Whitney U test.

³Chi-square test.

Values are expressed as n (%), mean ± SD, or median (interquartile range). P < 0.05 is present to be significant. CI: Confidence interval; DPE: Dural puncture epidural; EA: Epidural anesthesia.

Table 3 Sensory nerve and motor block levels in the two groups at each time point after drug injection

	Group	5 min	10 min	15 min	20 min	5 min after operation
Sensory block levels of cranial side	EA (n = 57)	T11 (T10-11)	T9 (T7-T9)	T6 (T5-T7)	T5 (T4-T6)	T5 (T5-T6)
	DPE (n = 58)	T10 (T10-11)	T8 (T7-T8)	T6 (T5-T6)	T5 (T4-T6)	T5 (T4-T6)
	95%CI	0.349-1.020	0.064-0.905	0.381-1.141	0.262-0.436	0.078-0.705
	P value	< 0.001	0.024	< 0.001	0.623	0.115
	Ptime < 0.001, Pgroup = 0.008, Pinteraction < 0.001
Sensory block levels of sacral side	EA (n = 57)	L1 (L1-L3)	L3 (L2.5-L4)	L5 (L4-S1)	S1 (S1-S1)	S1 (S1-S1)
	DPE (n = 58)	L2 (L2-L2.3)	L4 (L3-L4)	S1 (L5-S1)	S1 (S1-S2)	S1 (S1-S2)
	95%CI	0.471-0.966	0.245-0.992	0.319-0.925	0.078-0.710	0.269-0.734
	P value	< 0.001	0.001	< 0.001	0.015	< 0.001
	Ptime < 0.001, Pgroup < 0.001, Pinteraction = 0.425
Motor block score	EA (n = 57)	0.0 (0.0-0.0)	1.0 (0.0-1.0)	1.0 (1.0-2.0)	2.0 (1.0-3.0)	3.0 (2.0-3.0)
	DPE (n = 58)	1.0 (1.0-1.0)	1.0 (1.0-2.0)	2.5 (2.0-3.0)	3.0 (3.0-3.0)	3.0 (3.0-3.0)
	95%CI	0.443-0.757	0.631-1.153	0.773-1.354	0.507-1.008	0.210-0.636
	P value	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
	Ptime < 0.001, Pgroup < 0.001, Pinteraction < 0.0011

Values are expressed as median (interquartile range). The data were analyzed with linear mixed model. P_time: The time effect within group, the differences between the two groups at each timepoint were tested with adjusted bonferroni correction for multiple comparisons, P < 0.05 was considered statistically significant; P_group: The main effect between the epidural anesthesia and dural puncture epidural group over time; P_interaction: The interaction effect of group-by-time; CI: Confidence interval; DPE: Dural puncture epidural; EA: Epidural anesthesia.