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Background and Aims The Dural Puncture Epidural (DPE) seems to provide better sacral labor analgesia than the conventional Epidural (EPL) technique when performed with 25 and 26-G spinal needles. This double-blinded randomized controlled trial aims to investigate whether a 27-G needle DPE results in faster bilateral sacral blockade compared to EPL.

Methods Following ethics approval and written consent, 108 nulliparous women were included. 54 patients received a conventional EPL, while the DPE group (n=54) received a needle-through-needle dural puncture technique using a 27-G Whitacre needle. In both groups analgesia was initiated epidurally with 15 mL of ropivacaine 0.1% and sufentanil 0.5 mcg mL–1 and maintained with 10 ml bolus of the same mixture provided hourly through a Programmed Intermittent Epidural Bolus infusion. Bilateral sacral blockade was tested at the S2 dermatomes using a pin-prick examination 10 minutes after analgesia completion, then at pre-defined intervals until delivery.

Results Time to bilateral sacral blockade was significantly different in the two groups (hazard ratio 0.30, 95% confidence interval [CI] 0.19 to 0.48, P<0.001). One hour after analgesia initiation 94% DPE patients achieved bilateral sacral blockade compared to 63% of the EPL group (P <0.001), with greater results at 10 minutes (risk ratio [RR] 3.00, 95% CI 1.69 to 5.29; P<0.001) and at 20 minutes (RR 2.38, 95% CI 1.35 to 4.21; P=0.001).

Conclusions Within 1 hour after initiation of neuraxial analgesia, the DPE technique using a 27-G Whitacre spinal needle provides an improved S2 dermatomes coverage compared to EPL.