Dural puncture epidural vs traditional epidural: A meta- analysis with trial sequential analysis of labor analgesia

Abstract

Abstract Purpose Dural puncture epidural (DPE) is a modified version of traditional epidural (EPL) that is performed by puncturing the dura mater with a spinal needle without intrathecal drug administration. We performed an updated meta-analysis of randomized controlled trials with trial sequential analysis (TSA) to compare the benefits and risks of DPE with those of EPL for labor analgesia in parturients. Methods Web of Science, Embase, PubMed, and the Cochrane Library were searched from inception to March 2023. The meta-analysis was conducted using fixed- or random-effects models to estimate risk ratios and mean differences (MDs) with 95% confidence intervals (CIs). The reliability of the meta-analysis results was examined using TSA. The primary outcome was the time to adequate analgesia, defined as a pain score of ≤ 3/10 (or 30/100). The secondary outcomes were maternal delivery and neonatal outcomes, quality of analgesia, and adverse effects. Results Twelve studies involving 1,259 patients were included. Compared with EPL, DPE required 4 fewer minutes to achieve a pain score of ≤ 3/10 (or 30/100) (weighted MD − 3.99, 95% CI − 4.54 to − 3.44, I2 (article heterogeneity) = 42%, p < 0.00001), and TSA confirmed these results. There were no significant differences in the secondary outcomes, except for the incidence of motor block. However, the TSA did not support all of the secondary outcomes. Conclusion Compared with EPL, DPE allowed faster relief of labor pain. There was no significant difference in the incidence of spontaneous and instrumental vaginal delivery, catheter adjustment and replacement, pruritus, post-dural puncture headache, or paresthesia between the two techniques.