Modification of combined spinal-epidural analgesia in labor
The review considers the capabilities and technical features of the neuraxial technique of epidural analgesia with dural puncture epidural (DPE) for labor pain relief. Technically, DPE is a modification of combined spinal-epidural analgesia, in which the dura mater is punctured without subsequent intrathecal administration of a drug. At the moment, the published results of studies do not reveal that DPE has a clear advantage over epidural analgesia. At the same time, some studies show a faster onset of analgesia, a pronounced sacral block, and a decrease in the frequency of an asymmetric block with DPE. One study demonstrates that DPE has a more common side effect as paresthesia. It is difficult to interpret the data of comparative studies due to the lack of a clear protocol for this technique. In the authors’ opinion, improving the protocol for the DPE technique will be able to better identify its advantages and disadvantages.Pismensky S.V., Pyregov A.V., Baev O.R., Tysyachnyi O.V., Perevarova Yu.S.
Keywords
epidural analgesia
labor pain
labor pain relief
References
- Sng B.L., Kwok S.C., Sia A.T.H. Modern neuraxial labour analgesia. Curr. Opin. Anaesthesiol. 2015; 28(3): 285–9. doi: 10.1097/ACO.0000000000000183.
- Littleford J. Effects on the fetus and newborn of maternal analgesia and anesthesia: a review. Can. J. Anesth. Can. Anesth. 2004; 51(6): 586–609. doi: 10.1007/BF03018403
- Гурьянов В.А., Пырегов А.В., Гельфанд Б.Р., Куликов А.В. Анестезия в акушерстве / В кн.: Бунятян А.А., Мизиков В.М., ред. Анестезиология. Национальное руководство. Краткое издание. М.: ГЭОТАР-Медиа, 2015. С. 444–64. [Guryanov V.A., Pyregov A.V., Gelfand B.R., Kulikov A.V. Anesthesia in obstetrics. In: Bunyatyan A.A., Mizikov V.M., ed. Anesthesiology. National guideline. Short edition. Moscow: GEOTAR-Media, 2015. Р. 444-64. (in Russian)]
- Адамян Л.В., Артымук Н.В., Белокриницкая Т.Е., Куликов А.В., Овезов А.М., Петрухин В.А., Проценко Д.Н., Упрямова Е.Ю., Филиппов О.С., Шифман Е.М., Шмаков Р.Г. Нейроаксиальные методы обезболивания родов. Проблемы репродукции. 2018; 24(S6): 501–21. [Adamyan L.V., Artymuk N.V., Belokrinitskaya T.E., Kulikov A.V., Ovezov A.M., Petrukhin V.A., Protsenko D.N., Upryamova E.Yu., Filippov O .S., Shifman E.M., Shmakov R.G. Neuroaxial methods of labor analgesia Problemy reproduktsii/Russian Journal of Human Reproduction. 2018; 24(S6): 501–21.(in Russian)]. eLIBRARY ID: 37311765
- Cambic C.R., Wong C.A. Labour analgesia and obstetric outcomes. Br. J. Anaesth. 2010; 105: 50–60. doi: 10.1093/bja/aeq311.
- Баев О.Р., Козлова О.А., Рубцова С.В., Румянцева В.П., Пырегов А.В. Влияние эпидуральной аналгезии на продолжительность родов, частоту слабости родовой деятельности и кесарева сечения. Акушерство и гинекология. 2014; 6: 41–6. [Baev O.R., Kozlova O.A., Rubtsova S.V., Rumyantseva V.P., Pyregov A.V. Effect of epidural analgesia on the duration of labor and the incidence of uterine inertia and cesarean section. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2014; 6: 41–6. (in Russian)].
- Тысячный О.В., Баев О.Р., Евграфова А.В., Приходько А.М., Письменский С.В. Кислотно-основное состояние и газовый состав пуповинной крови в зависимости от использования эпидуральной аналгезии в родах через естественные родовые пути. Акушерство и гинекология. 2019; 5: 70–6. [Tysyachnyy O.V., Baev O.R., Evgrafova A.V., Prikhodko A.M., Pismensky S.V. Umbilical cord blood acid-base balance and gas composition in relation to the use of epidural analgesia in vaginal delivery. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2019; 5: 70–6. (in Russian)]. doi:10.18565/aig.2019.5.70-76
- Упрямова Е.Ю., Шифман Е.М., Овезов А.М., Новикова С.В., Ельчанинова А.Г., Чаплыгина О.В. Влияние методов обезболивания самопроизвольных родов на организм матери и плода // Альманах Клинической Медицины. 2018; 46(2): 137–45. [Upriamova E.Y., Shifman E.M., Ovezov A.M., Novikova S.V., El’chaninova A.G., Chaplygina O.V. Maternal and fetal effects of analgesia and anesthesia in spontaneous labor. Almanac of Clinical Medicine. 2018; 46(2): 137–145. (In Russ.)] https://doi.org/10.18786/2072-0505-2018-46-2-137-145
- Heesen M., Van de Velde M., Klöhr S., Lehberger J., Rossaint R., Straube S. Meta-analysis of the success of block following combined spinal-epidural vs epidural analgesia during labour. Anaesthesia. 2014; 69(1): 64–71. doi: 10.1111/anae.12456.
- Chau A., Tsen L.C. Dural Puncture Epidural Technique: a Novel Method for Labor Analgesia. Curr. Anesthesiol. Rep. 2017; 7(1): 49–54. https://doi.org/10.1007/s40140-017-0197-6
- Chau A., Bibbo C., Huang C.-C., Elterman K.G., Cappiello E.C., Robinson J.N., Tsen L.C. 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. 2017; 124(2): 560–9. doi: 10.1213/ANE.0000000000001798
- Layera S., Bravo D., Aliste J., Tran D.Q. A systematic review of DURAL puncture epidural analgesia for labor. J. Clin. Anesth. 2019; 53: 5–10. doi: 10.1016/j.jclinane.2018.09.030.
- Suzuki N., Koganemaru M., Onizuka S., Takasaki M. Dural Puncture with a 26-Gauge Spinal Needle Affects Spread of Epidural Anesthesia .Anesth. Analg. 1996; 82(5): 1040–2. doi: 10.1097/00000539-199605000-00028
- Heesen M., Rijs K., Rossaint R., Klimek M. Dural puncture epidural versus conventional epidural block for labor analgesia: a systematic review of randomized controlled trials. Int. J. Obstet. Anesth. 2019; doi: 10.1016/j.ijoa.2019.05.007
- Bernards C., Kopacz D., Michel M. Effect of needle puncture on morphine and lidocaine flux through the spinal meninges of the monkey in vitro. Implications for combined spinal-epidural anesthesia. Anesthesiology. 1994; 80(4): 853–8. doi: 10.1097/00000542-199404000-00019
- Thomas J.A., Pan P.H., Harris L.C., Owen M.D., D’Angelo R. Dural puncture with a 27-gauge Whitacre needle as part of a combined spinal-epidural technique does not improve labor epidural catheter function // Anesthesiology. 2005; 103(5): 1046–51. doi: 10.1097/00000542-200511000-00019
- Clement R., Malinovsky J.-M., Corre P.L., Dollo G., Chevanne F., Verge R.L. Cerebrospinal Fluid Bioavailability and Pharmacokinetics of Bupivacaine and Lidocaine after Intrathecal and Epidural Administrations in Rabbits Using Microdialysis. 1999; 289: 7. PMID: 10215682
- Wilson S.H., Wolf B.J., Bingham K., Scotland Q.S., Fox J.M., Woltz E.M., Hebbar L. 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. 2018; 126(2): 545–51. doi: 10.1097/01.aoa.0000542332.82901.be
- Contreras F., Morales J., Bravo D., Layera S., Jara Á., Riaño C., Pizarro R., De La Fuente N., Aliste J., Finlayson R.J., Tran D.Q. Dural puncture epidural analgesia for labor: a randomized comparison between 25-gauge and 27-gauge pencil point spinal needles. Reg. Anesth. Amp Pain Med. 2019; pii: rapm-2019-100608. doi: 10.1136/rapm-2019-100608.
- Cappiello E., OʼRourke N., Segal S., Tsen L.C. A Randomized Trial of Dural Puncture Epidural Technique Compared with the Standard Epidural Technique for Labor Analgesia. Anesth. Analg. 2008; 107(5): 1646–51. doi: 10.1213/ane.0b013e318184ec14.
- Yadav P., Kumari I., Narang A., Baser N., Bedi V., Dindor B. Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida. J. Obstet. Anaesth. Crit. Care. 2018; 8(1): 24. doi: 10.4103/joacc.JOACC_32_17
- Gupta D., Srirajakalidindi A., Soskin V. Dural puncture epidural analgesia is not superior to continuous labor epidural analgesia. Middle East J Anaesthesiol. 2013; 22(3): 309–16. PMID: 24649788
Received 03.09.2019
Accepted 04.10.2019
About the Authors
Sergey V. Pismensky, doctor of the Department of Anaesthesiology and Resuscitation, assistant of the Department of Anesthesiology and Resuscitation,National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia.
Tel.: +74954387777. E-mail: smsu@mail.ru
117997, Russia, Moscow, Ac. Oparina str. 4.
Aleksey V. Pyregov, MD, associate professor, head of the Department of Anesthesiology and Resuscitation, National Medical Research Center for Obstetrics,Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia. Tel.: +74954387777. E-mail: a_pyregov@oparina4.ru
117997, Russia, Moscow, Ac. Oparina str. 4.
Oleg R. Baev, MD, professor, head of the first Maternity Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia. Tel.: +74954381188. E-mail: o_baev@oparina4.ru; I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Department of Obstetrics, Gynecology, Perinatology and Reproduction.
117997, Russia, Moscow, Ac. Oparina str. 4.
Oleg V. Tysyachnyy, PhD., junior scientific researcher of the first maternity departments, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia. Tel.: +74954381188. E-mail: olti23@mail.ru
117997, Russia, Moscow, Ac. Oparina str. 4.
Yulia S. Perevarova, resident, Pirogov Russian National Research Medical University. 117997, Russia, Moscow, Ostrovityanova str. 1. Tel.: +79774920076. E-mail: perevarova.y@gmail.com
For citation: Pismensky S.V., Pyregov A.V., Baev O.R., Tysyachnyi O.V., Perevarova Yu.S. Modification of combined spinal-epidural analgesia in labor.
Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2020; 1: 34-9. (In Russian).
https://dx.doi.org/10.18565/aig.2020.1.34-39
Similar Articles
