Comparison of Surgical Anesthesia Onset Between Dural-Puncture Epidural and Standard Epidural Techniques for Emergency Cesarean Section: Protocol for a Randomized Controlled Trial.

Purpose: The dural-puncture epidural (DPE) and standard epidural (EP) techniques are well-established methods for neuraxial analgesia during labor. However, there is limited knowledge regarding the conversion of DPE-induced labor analgesia to surgical anesthesia during cesarean sections, particularly regarding efficacy and timing. This study will compare the surgical anesthesia onset time between DPE and EP in parturients undergoing emergency cesarean delivery after conversion from labor analgesia.

Patients and methods: This double-blind, randomized clinical study will include 124 parturients. Parturients aged ≥18 years with singleton pregnancies who request labor analgesia will be randomly assigned to receive either DPE or EP anesthesia in the labor and delivery rooms. Participants will be excluded if they have contraindications to neuraxial anesthesia, back surgery or scoliosis history, significant fetal anomalies, or a known allergy to any of the study medications. Epidural labor analgesia will be maintained using a low concentration of ropivacaine in combination with sufentanil, delivered through the epidural catheter. During delivery, an emergency intrapartum cesarean section following labor analgesia may be necessary among these parturients. Parturients requiring intrapartum cesarean delivery following labor analgesia will be eligible. Epidural extension anesthesia will be administered in the operating room. The primary outcome measure will be the time from chloroprocaine administration to the achievement of a surgical level of anesthesia, defined as a T6 sensory block. Secondary outcomes will include epidural anesthesia quality, incidence of conversion to cesarean section between the two techniques, and maternal and neonatal outcomes.

Conclusion: This study will estimate the onset time to achieve surgical anesthesia during epidural extension using a DPE compared to an EP technique. The results may provide a deeper understanding of the advantages of the DPE technique in labor analgesia, as well as determine the onset time and reliability of anesthesia block during conversion from labor analgesia to cesarean delivery.

Trial registration: ChiCTR2400089237. Registered September 4, 2024.