Conclusions
In the context of our study, a DPE performed within an hour of epidural extension for elective cesarean delivery was associated with a faster onset of anesthesia, improved block quality, and a favorable risk-to-benefit ratio compared with standard epidural. Further studies are needed to investigate whether these findings can be validated in the clinical context of intrapartum cesarean deliveries, whether these benefits persist with different local anesthetic mixtures and timings from DPE to epidural extension, and to confirm neonatal outcomes.