Introduction
labor
SECONDARY
Neuraxial analgesia is considered the criterion standard for labor and delivery, with an estimated 71% of parturients in the US receiving some form of neuraxial analgesia.The DPE technique is similar to the combined spinal-epidural technique but without the injection of intrathecal drugs. First, the epidural space is identified with an epidural needle, and then a spinal needle is inserted through the epidural needle to puncture the dura. After confirmation of clear cerebrospinal fluid, the spinal needle is then removed, and the epidural catheter is inserted to initiate analgesia. The hypothesized advantage of the DPE over the standard epidural technique is improved analgesia secondary to epidural midline placement through the confirmation of cerebrospinal fluid flow through the spinal needle. Dural puncture with a DPE may also facilitate translocation of epidural medications into the intrathecal space to improve analgesia.In view of the increasing use of DPE and its proposed advantages for labor analgesia, we conducted a double-blind, randomized clinical trial (RCT) to determine whether the DPE technique is superior to the standard epidural when used for epidural extension anesthesia in parturients undergoing elective cesarean delivery. We hypothesized that DPE would provide faster onset of surgical anesthesia compared with the standard epidural technique. We also sought to determine whether DPE would improve the overall quality and reliability of epidural anesthesia.