Eight nulliparous parturients were randomly assigned to treatments dural puncture epidural (DPE) and without dural puncture (E). In patients who received a dural puncture (DPE), a single puncture with confirmation of free flow CSF was performed using a 25G spinal needle. In the standard epidural group (E) the spinal needle was removed without performing a dural puncture. Bupivacaine was administered over 5 min through a catheter, followed by the immediate initiation of patient-controlled epidural analgesia.
Effects of analgesia were evaluated by assessing visual analog scale (VAS) pain scores, sensory level, and motor blockade were measured up to 30 minutes after bupivacaine. Assessments continued at regular 90-minute intervals; including additional anesthetic interventions and side effects. The primary measurements in this trial were the presence of sacral dermatome (S1) blockade (either unilateral or bilateral) and a VAS analgesia score of <10 within 20 min of initiation of epidural analgesia.
Appropriate statistical analysis was performed. Conclusion of the study The sacral spread, onset of pain relief, and bilateral pain relief produced by bupivacaine with fentanyl in laboring nulliparous patients improved with dural puncture using a 25-G spinal needle immediately before the initiation of epidural analgesia. Is it a valid assumption based on the data of the study? Describe the applicability and relevance of the paper to clinical practice.
The conclusion is valid based on the data presented in the study. Parturiens with prior dural puncture before epidural analgesia was administered showed significantly more frequent blockade of the S1 dermatome, more visual analog scale scores of <10/100 at 20 min and reduced one-sided analgesia. The data clearly shows that the treatment was effective in brining faster onset of pain relief during labor.
The results of the paper are relevant to clinical practice because it presents a technique for bringing faster pain relief during childbirth labor. Also, the technique can be applied to patients who are in extreme pain (like those who are in car accidents or burn patients) who require rapid pain relief to allow for immediate surgical and other emergency procedures.
References
Birnbach, D. J. (2004). Advances in Labor Analgesics. Canadian Journal of Anesthesia , 51, R12. Cappiello, E. , O’ Rourke, N. , Segal, S. , & Tsen, L. (2008). A Randomized Trial of Dural Puncture Epidural Technique Compared with the Standard Epidural Technique for Labor Analgesia. 107 (5), 1646-1651. Eltzschig, H. , Lieberman, E., & Camann, W. (2003). Regional Anesthesia and Analgesia for Labor and Delivery. New England Journal of Medicine (348), 319-332.