The place of dural puncture epidural as a modern method of pain relief in labor

Authors

  • A.O. Zhezher Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine
  • Ye.M. Sulimenko Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine; Leleka Maternity Hospital, Kyiv, Ukraine
  • O.A. Loskutov Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.17.2.2021.230660

Keywords:

pain relief in labor, epidural analgesia, combined spinal-epidural analgesia, dural puncture epidural, hypotension

Abstract

Childbirth is a physiological process that is accompanied by severe pain. Physiological and psychological factors may be involved in the pathological process. Increasing the concentration of catecholamines may help reduce uteroplacental perfusion. Pain during childbirth can lead to hyperventilation of the mother, which in turn can affect the acid-base status of the fetus and the state of the newborn. Prolonged pain can lead to the development of severe psychological disorders with a violation of the connection between mother and newborn. Acute pain during childbirth can transform into chronic in the postpartum period. The most effective are neuroaxial methods of analgesia: epidural analgesia, combined spinal-epidural analgesia and their modifications. Classical epidural analgesia has minimal adverse and side effects, but may be associated with a high incidence of insufficient analgesia. The frequency of inadequate epidural block reaches 23 %. Combined spinal-epidural analgesia, in contrast to epidural analgesia, has a higher quality of sensory block, but it is associated with a higher frequency of side effects such as hypotension, severe motor block, fetal arrhythmia. Since 2005, dural puncture epidural has been introduced into the practice of obstetric anesthesiologists as a method to improve the quality of classical epidural analgesia with minimal side effects of combined spinal-epidural analgesia. Data from existing studies show that dural puncture epidural potentially improves the quality of analgesia (faster onset of analgesia, better sacral coverage, lower incidence of inadequate block) compared with epidural analgesia and causes less hypotension, disorders of fetal heart rate compared with combined spinal-epidural analgesia. But the spinal needle size is important in achieving these effects. Further researches may be aimed at determining the duration of labor, the option of delivery and the possible impact of dural puncture epidural on the vegetative regulation of labor and a broader study of the impact of this method on the fetus and newborn.

References

Шакиров Р.Т., Кинжалова С.В., Макаров Р.А. Нейроаксиальные методы обезболивания родов. Вестник анестезиологии и реаниматологии. 2018. Т. 15. № 5. С. 65-73. DOI: 10.21292/2078-5658-2018-15-5-65-73.

Jalal A. Nanji, Brendan Carvalho. Pain management during labor and vaginal birth. Best Practice & Research Clinical Obstetrics & Gynaecology. 2020. Vol. 67. P. 100-112.

Sng B.L., Kwok S.C., Sia A.T. Modern neuraxial labour analgesia. Cur. Opin. Anaesth. 2015. Vol. 28. № 3. P. 285-289.

Gonzalez M.N., Trehan G., Kamel I. Pain management during labor, part 1: Pathophysiology of labor pain and maternal evaluation for labor analgesia. Topics Obstetr. Gynecology. 2016. Vol. 36. № 11. P. 1-6.

Labor S., Maguire S. The pain of labour. Rev. Pain. 2008. Vol. 2. № 2. P. 15-19.

Wong C.A. Advances in labor analgesia. Intern. J. Women’s Health. 2009. Vol. 1. P. 139-154.

Полушин Ю.С., Коростелев Ю.М., Вартанова И.В. и др. Болевой синдром после родов и его влияние на качество жизни. Анестезиол. и реаниматол. 2015. № 2. С. 47-50.

Куликов А.В., Шифман Е.М. Анестезия, интенсивная терапия и реанимация в акушерстве и гинекологии. Клинические рекомендации. Протоколы лечения. 2-е изд., доп. и перераб. М.: Медицина, 2017. С. 153-168.

Clark V., Van de Velde M., Fernando R. (eds.). Oxford textbook of obstetric anaesthesia. Oxford UK: Oxford University press, 2016. 1072 p.

Committee on practice bulletins — obstetrics. ACOG Practice bulletin No. 177: Obstetric analgesia and anesthesia. Obstet. Gyneco-logy. 2017. Vol. 129. № 4. P. 73-89.

Kocarev M., Khalid F., Khatoon F. et al. Neuraxial labor ­analgesia: a focused narrative review of the 2017 literature. Cur. Opin. Anaesth. 2018. Vol. 31. № 3. P. 251-257.

NICE Pathways Intrapartum care 2020; https://pathways.nice.org.uk/pathways/intrapartum-care

American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 209: Obstetric analgesia and anesthesia. Obstetrics and Gynecology. 2019. 133(3). Р. 208-225.

Shatalin D., Weiniger C.F., Buchman I., Ginosar Y., Orbach-Zinger S., Ioscovich A. A 10-year update: national survey questionnaire of obstetric anesthesia units in Israel. International journal of obstetric anesthesia. 2019. 38. Р. 83-92.

Bos E.M., Schut M.E., de Quelerij M., Kalkman C.J., Hollmann M.W., Lirk P. Trends in practice and safety measures of epidural analgesia: Report of a national survey. Acta Anaesthesiologica Scandinavica. 2018. 62(10). Р. 1466-1472.

Guasch E., Brogly N., Gilsanz F. Combined spinal epidural for labour analgesia and caesarean section: indications and recommendations. Current Opinion in Anesthesiology. 2020. 33(3). Р. 284-290.

Chau A., Bibbo C., Huang C.C. et al. 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. Analgesia. 2017. Vol. 124. № 2. P. 560-569.

Guasch E., Iannuccelli F., Brogly N., Gilsanz F. Failed epidural for labor: what now? Minerva Anestesiologica. 2017. 83(11). Р. 1207-1213.

Layera S., Bravo D., Aliste J., Tran D.Q. A systematic review of dural puncture epidural analgesia for labor. Journal of Сlinical Аnesthesia. 2019. 53. Р. 5-10.

Hattler J., Klimek M., Rossaint R. et al. The effect of combined spinal-epidural versus epidural analgesia in laboring women on nonreassuring fetal heart rate tracings: systematic review and meta-analysis. Anest. Analg. 2016. Vol. 123. № 4. P. 955-964.

Heesen M., Van de Velde M., Klöhr S. et al. Meta-analysis of the success of block following combined spinal-epidural vs epidural analgesia during labour. Anaesthesia. 2014. Vol. 69. № 1. P. 64-71.

Suzuki N., Koganemaru M., Onizuka S., Takasaki M. Dural puncture with a 26-gauge spinal needle affects spread of epidural anesthesia. Anesthesia & Analgesia. 1996. 82(5). Р. 1040-1042.

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: The Journal of the American Society of Anesthesiologists. 2005. 103(5). Р. 1046-1051.

Yadav P., Kumari I., Narang A., Baser N., Bedi V., Dindor B.K. Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida. J. Obstet. Anaesth. Crit. Care. 2018. 8(1). Р. 24-28.

Wilson S.H., Wolf B.J., Bingham K.N. et al. Labor analgesia onset with dural puncture epidural versus tradicional epidural using a 26-gauge Whitacre needle and 0.125% bupivacaine bolus: a rando-mized clinical trial. Anesth. Analg. 2018. 126. Р. 545-551.

Cappiello E., O’Rourke 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. 1646e51.

Gupta D., Srirajakalisindi A., Soskin V. Dural puncture epidural analgesia is not superior to continuous labor epidural analgesia. MEJ Anesth. 2013. 22(3). Р. 309-316.

Published

2021-05-24

Issue

Section

Practicing Physician