Comparison of the Dural Puncture Epidural and Conventional Epidural Analgesia Maintained Using Programmed Epidural Boluses for Labor Analgesia.

IF 5.1 2区医学 Q1 CHEMISTRY, MEDICINAL

Drug Design, Development and Therapy Pub Date : 2025-05-26 eCollection Date: 2025-01-01 DOI:10.2147/DDDT.S521681

Xiaofei Mo, Jie Yu, Zhimin Qin, Junyi Ma, Yueyue Chen, Xi Chen

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引用次数: 0

Abstract

Purpose: Research indicates that the dural puncture epidural (DPE) technique offers quicker analgesia onset compared to the conventional epidural (EP) technique. Programmed intermittent epidural bolus (PIEB) is superior to continuous epidural infusion (CEI) for maintaining labor analgesia, providing better pain relief and less motor block. Few studies have explored if combining DPE with the PIEB offers additional benefits in analgesia onset, maintenance, local anesthetic consumption, and side effects compared to DPE with EP. We hypothesized that DPE, when combined with PIEB, not only speeds up analgesia onset but also improves neuraxial analgesia maintenance over EP.

Patients and methods: A total of 126 term nulliparous women with singleton pregnancies with a VAS pain score >50 mm and cervical dilation <5 cm were randomized to receive EP+PIEB or DPE+PIEB for labor analgesia, initiated with 15 mL of 0.0625% ropivacaine with 0.4 µg/mL of sufentanil using the EP or DPE technique (using 25-gauge Whitacre needle) technique and both maintained with the same solution for PIEB (fixed volume 10 mL, intervals 45 minutes, lockout interval 15 minutes) with labor analgesia. The primary outcome was time to achieving adequate analgesia, defined as a VAS pain score ≤30 mm. Secondary outcomes included pain scores, motor blockade, obstetric and neonatal outcomes, and satisfaction with analgesia.

Results: Adequate analgesia was achieved faster in the DPE+PIEB group than in the EP+PIEB group (hazard ratio 2.409; 95% CI 1.670 to 3.474, P<0.001). The median time (interquartile range) to VAS pain score ≤30 mm was 10 (7 to 13) minutes for the DPE+PIEB group and 15 (11 to 19) minutes for the EP+PIEB group (P<0.001). No differences in any of the secondary outcomes between the two groups were observed.

Conclusion: DPE with PIEB accelerated onset time but did not improve maintenance of neuraxial labor analgesia over DPE with EP.

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硬膜穿刺硬膜外镇痛与常规硬膜外镇痛的比较。

目的：研究表明硬膜穿刺硬膜外（DPE）技术比传统的硬膜外（EP）技术具有更快的镇痛作用。程序性间歇硬膜外输注（PIEB）在维持分娩镇痛方面优于连续硬膜外输注（CEI），提供更好的疼痛缓解和更少的运动阻滞。很少有研究探讨与DPE联合EP相比，DPE联合PIEB是否在镇痛起效、维持、局部麻醉消耗和副作用方面具有额外的益处。我们假设DPE联合PIEB不仅加速了镇痛的发生，而且改善了EP期间的轴向镇痛维持。患者和方法：126例VAS疼痛评分为bbb50 mm、宫颈扩张的单胎足月无产妇女。结果：DPE+PIEB组比EP+PIEB组更快获得充分的镇痛(风险比2.409；结论：与epb组相比，pib组的DPE组加快了起效时间，但没有改善神经轴分娩镇痛的维持。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.