Analgesia in childbirth - comparison and analysis of the classical technique of epidural analgesia and modified with puncture of the dura mater




epidural analgesia, dural puncture epidural (DPE), systemic hemodynamics, central hemodynamics


Epidural analgesia (EA), most commonly used for labor analgesia, is an effective and relatively safe technique, but may be associated with slow onset, inadequate block. The use of Dural puncture epidural (DPE) is designed to find a balance between improving the quality of analgesia and reducing the frequency of side effects.

Purpose - to compare two methods of labor analgesia.

Materials and methods. All women (n=80) were divided into two groups: the Group I (n=40) used DPE, the Group II (n=40) used EA. In both groups, the same technique of epidural puncture and catheterization was used, in the Group I additionally puncture of the dura mater. Analgesia was evaluated using the visual analog pain rating scale (VAS). The quality and effectiveness of analgesia, the hemodynamics of the woman were evaluated. Complications and unwanted effects were recorded. Fetal condition: cardiotocography (CTG), umbilical cord blood lactate, pH. A statistical analysis of the obtained data was carried out.

Results. The first contraction (VAS<1) in the Group I were fixed on 11.4±3.3 min, and in the Group II on 21.5±7.2 min (p<0.05). Monolateral block in the Group I - 4 (10%) versus 10 (25%) (p<0.05). Contractions (VAS <1) after 30 min in the Group II - 7 (17.5%) versus the absence of such in the Group I. Stroke volume in the Group I decreased by 2.1% versus 1.5% in the Group II. The data for hypotension and occurrence of complications, CTG, cord blood lactate, and pH were not different by group.

Conclusions. The use of the DPE technique against EA gives better results in terms of the quality and effectiveness of analgesia. The mother’s hemodynamics remained stable when using DPE. The DPE technique does not increase the frequency of complications compared to EA. There was no difference between the groups when assessing the state of the fetus according to CTG data, pH indicators and umbilical cord blood lactate.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interest was declared by the author.

Author Biography

Ye.M. Sulimenko, Shupyk National Healthcare University of Ukraine, Kyiv

«Leleka» Maternity Hospital» LLC, Kyiv, Ukraine


ACOG. (2019, Mar). American College of Obstetricians and Gynecologists' Committee on Practice Bulletins - Obstetrics. ACOG Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstet Gynecol. 133 (3): e208-e225.; PMid:30801474

Cappiello E, O'Rourke N, Segal S et al. (2008, Nov). Randomized trial of dural puncture epidural technique compared with the standard epidural technique for labor analgesia. Anesth Analg. 107 (5): 1646-1651.; PMid:18931227

Chau A, Bibbo C, Huang CC et al. (2017, Feb). Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques: A Randomized Clinical Trial. Anesth Analg. 124 (2): 560-569.; PMid:28067707

Guasch E, Iannuccelli F, Brogly N at al. (2017, Nov). Failed epidural for labor: what now? Minerva Anestesiol. 83 (11): 1207-1213. Epub 2017 Jun 12.; PMid:28607343

Hattler J, Klimek M, Rossaint R at al. (2016, Oct). The Effect of Combined Spinal-Epidural Versus Epidural Analgesia in Laboring Women on Nonreassuring Fetal Heart Rate Tracings: Systematic Review and Meta-analysis. Anesth Analg. 123 (4): 955-964. Erratum in: Anesth Analg. 2018 Jan; 126 (1): 372.; PMid:27509225

Lim G, Facco FL, Nathan N at al. (2018, Jul). Review of the Impact of Obstetric Anesthesia on Maternal and Neonatal Outcomes. Anesthesiology. 129 (1): 192-215.; PMid:29561267 PMCid:PMC6008182

Macones GA, Hankins GD, Spong CY at al. (2008). The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. Obstet Gynecol. 112: 661-666.; PMid:18757666

Merskey H, Bogduk N. (eds.). (1994). Classification of chronic pain, second edition. Seattle: IASP press.: 210.

Ministerstvo okhorony zdorovʼia Ukrainy. (2023). Nakaz Ministerstva okhorony zdorovʼia Ukrainy vid 5.01.2023 roku No. 8. URL:

NICE. (2016). Intrapartum care. Guidance. URL:

Tan HS, Reed SE, Mehdiratta JE et al. (2022, May 1). Quality of Labor Analgesia with Dural Puncture Epidural versus Standard Epidural Technique in Obese Parturients: A Double-blind Randomized Controlled Study. Anesthesiology. 136 (5): 678-687.; PMid:35157756

Thomas JA, Pan PH, Harris LC et al. (2005, Nov). Dural puncture with a 27-gauge Whitacre needle as part of a combined spinal-epidural technique does not improve labor epidural catheter function. Anesthesiology. 103 (5): 1046-1051.; PMid:16249679

Upriamova EIu, Shyfman EM, Ovezov AM y dr. (2018). Vlyianye metodov obezbolyvanyia samoproyzvolnikh rodov na orhanyzm matery y ploda. Almanakh klynycheskoi medytsyni. 46 (2): 137-145.

Wang L, Liu H, Duan Y at al. (2021, Nov 25). Analgesic Effects of Epidural Labor Analgesia at Different Periods and Its Effects on Maternal and Infant Outcomes and MiRNA-146b Level. J Healthc Eng. 2021: 2879678.; PMid:34868513 PMCid:PMC8639244

Wang X, Wang Y, Zhou S et al. (2009). Women's postpartum practices and chronic pain in rural China. Matern Child Health J. 13: 206-212.; PMid:18351447

Wilson SH, Wolf BJ, Bingham K at al. (2018, Feb). Labor Analgesia Onset With Dural Puncture Epidural Versus Traditional Epidural Using a 26-Gauge Whitacre Needle and 0.125% Bupivacaine Bolus: A Randomized Clinical Trial. Anesth Analg. 126 (2): 545-551.; PMid:28622178 PMCid:PMC7179732

Yadav P, Kumari I, Narang A at al. (2018). Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida. Journal of Obstetric Anaesthesia and Critical Care. 8 (1): 24.