Effect of Dural-Puncture Epidural vs Standard Epidural for Epidural Extension on Onset Time of Surgical Anesthesia in Elective Cesarean Delivery

• DOI: 10.1001/jamanetworkopen.2023.26710
• Publication Date: 2023-08-01T15:01:00Z
• Authors: Nadir Sharawi; Matthew Williams; Waseem Athar; Caroline Martinello; Kyle Stoner; Cameron Taylor; Nan Guo; Pervez Sultan; Jill M. Mhyre
• Keywords: Neuraxial Blockade; Cesarean delivery; Epidural block; Gold standard (test); Combined spinal epidural

Importance Dural-puncture epidural (DPE) and standard are common modes of neuraxial labor analgesia. Little is known about conversion DPE-initiated analgesia to surgical anesthesia for cesarean delivery. Objective To determine whether DPE provides a faster onset better-quality block compared with the technique Design, Setting, Participants This double-blind, randomized clinical trial was conducted between April 2019 October 2022 at tertiary care university hospital (University Arkansas Medical Sciences). included women aged 18 years older undergoing scheduled delivery singleton pregnancy. Interventions were receive or in room. A T10 sensory achieved maintained using low concentration bupivacaine fentanyl through catheter until time surgery. Epidural extension initiated operating Main Outcomes Measures The primary outcome taken from chloroprocaine administration (T6 block). secondary quality anesthesia, as defined by composite following factors: (1) failure achieve bilateral preoperatively room, (2) T6 within 15 minutes administration, (3) requirement intraoperative analgesia, (4) repeat procedure, (5) general anesthesia. Results Among 140 (mean [SD] age, 30.1 [5.2] years), 70 group, group. group had (median [IQR], 422 [290-546] seconds vs 655 [437-926] seconds; median [IQR] difference, 233 [104-369] seconds). rates lower 15.7% (11 women) 36.3% (24 66 (odds ratio, 0.33; 95% CI, 0.14-0.74; P = .007). Conclusions Relevance Anesthesia resulted improved during initiation technique. Further studies needed confirm these findings setting intrapartum Trial Registration ClinicalTrials.gov Identifier: NCT03915574