Sacral sensory blockade from 27-gauge pencil-point dural puncture epidural analgesia or epidural analgesia in laboring nulliparous parturients: a randomized controlled trial

Frassanito, L; Filetici, N; Piersanti, A; Vassalli, F; Van De Velde, M; Tsen, LC; Zanfini, BA; Catarci, S; Ciancia, M; Scorzoni, M; Olivieri, C; Draisci, G

doi:10.1016/j.ijoa.2024.104217

Obstetric anesthesia

Sacral sensory blockade from 27-gauge pencil-point dural puncture epidural analgesia or epidural analgesia in laboring nulliparous parturients: a randomized controlled trial

Int J Obstet AnesthPublished 14 Jun 2024Randomised controlled trial

Primary result · Bilateral S2 blockadeResultAbsolute risk reduction (ARR) 44% 95% CI 28–60

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Authors' conclusion

The DPE technique with a 27-gauge pencil-point spinal needle more often provides bilateral sacral blockade at 20 min following block initiation compared with the EPL technique.

Study context

Population: Laboring nulliparous parturients; analgesia initiated with ropivacaine 0.1% and sufentanil 0.5 μg/mL (15 mL), maintained via programmed intermittent epidural boluses54 per group
Participants: 108 participants

Comparison: Dural puncture epidural vs traditional epidural
Dural puncture epidural (DPE)n = 54
Epidural (EPL)n = 54reference
Primary endpoint: Bilateral sacral (S2) blockade
Follow-up: 20 min

Primary result

Bilateral S2 blockade

Absolute risk reduction (ARR)

44%

95% CI 28–60

P < 0.001

Events by treatment group

DPE87%47 of 54

EPL43%23 of 54

DPE vs EPL

absolute risk reduction (ARR) 44% (95% CI 28–60); P < 0.001

As reported in the abstract

Further findings

Outcome	← Lower risk with DPE ←→ Higher risk with DPE →	HR (95% CI)	P value
Time to NRS (0-10) ≤ 3	0.512	1.15 (0.77–1.15)	P = 0.50
	0.512Hazard ratio (log scale)

Outcome	DPE	EPL	P value
Number of rescue doses	0 (IQR 0–1)	0 (IQR 0–1)	P 0.08

Time to NRS (0-10) ≤ 3

Not significantly different between groups

Number of rescue doses

Not significantly different between groups

Bilateral S2 blockade at delivery

Not significantly different between groups

Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.

Original publication

Sacral sensory blockade from 27-gauge pencil-point dural puncture epidural analgesia or epidural analgesia in laboring nulliparous parturients: a randomized controlled trial. Int J Obstet Anesth. Published 14 June 2024. doi:10.1016/j.ijoa.2024.104217

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