Factors associated with successful initiation of labor analgesia using the dural puncture epidural technique: a retrospective cohort study.

Abstract

Purpose: The dural puncture epidural (DPE) technique has been proposed as a modification of conventional epidural analgesia that may influence onset and block quality. However, factors associated with successful initiation of labor analgesia using the DPE technique remain unclear. We aimed to identify predictors for successful initiation of labor analgesia using the DPE technique.

Methods: This retrospective study included parturients who received DPE for initiation of labor analgesia between April 2022 and March 2025. Success was defined as a composite outcome of epidural catheter placement within 15 min from initial skin puncture with the epidural needle and a numerical rating scale (NRS) pain score ≤ 3 recorded between 30 and 60 min after the first epidural bolus. Multivariable logistic regression was performed to identify independent predictors of success.

Results: Among the 1037 parturients included in the analysis, success was achieved in 693 cases, whereas 344 were classified as failures. In the multivariable analysis, operator experience (per 10 procedures) (odds ratio 1.10, 95% confidence interval 1.04 to 1.15, P < 0.001), baseline NRS (P < 0.001), cervical dilation at initiation (P = 0.038), maternal age (P = 0.013), and spinal disorder (P = 0.034) were identified as independent predictors of success.

Conclusion: Operator experience was independently associated with successful initiation of labor analgesia using the DPE technique and was the only factor associated with both procedural success and early analgesic effectiveness. Operator- and patient-related factors should be considered when predicting the likelihood of successful initiation of labor analgesia using the DPE technique.