Labor Analgesia Initiation With Dural Puncture Epidural Versus Conventional Epidural Techniques: A Randomized Biased-Coin Sequential Allocation Trial to Determine the Effective Dose for 90% of Patients of Bupivacaine
Authors' conclusion
Using a biased-coin, sequential allocation method, the DPE technique requires less bupivacaine to achieve effective initial analgesia (ED90) when compared to the EPL technique.
Study context
- Population
- Women of mixed parity with term, singleton gestation at ≤5 cm dilation with no major comorbidities95 analysed
- Participants
- 100 women
- Comparison
- Dural puncture epidural (DPE) vs epidural (EPL)
- Primary endpoint
- ED90 of bupivacaine for initial labor analgesia (success numeric rating scale (NRS) < 3 at 30 minutes), estimated by centered isotonic regression
- Follow-up
- 30 minutes
Methodological detailsbiased-coin sequential allocation, blinded outcome assessment, dose-finding, Bupivacaine diluted with 0.9% saline to 20 mL via the EPL catheter; dose set by the previous subject's response
- Biased-coin sequential allocation
- Blinded outcome assessment
- Dose-finding
- Bupivacaine diluted with 0.9% saline to 20 mL via the EPL catheter; dose set by the previous subject's response
Primary result
As reported in the abstract
ED90 of bupivacaine
Original publication
Labor Analgesia Initiation With Dural Puncture Epidural Versus Conventional Epidural Techniques: A Randomized Biased-Coin Sequential Allocation Trial to Determine the Effective Dose for 90% of Patients of Bupivacaine. Anesth Analg. Published 12 October 2023. doi:10.
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