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OP006 Effect on sacral spread of local anesthetic with 27-G spinal needle dural puncture epidural analgesia compared to epidural analgesia during labor: a randomised, controlled trial
  1. Nicoletta Filetici1,
  2. Luciano Frassanito1,
  3. Marc Van de Velde2,
  4. Lawrence Tsen3,
  5. Bruno Antonio Zanfini1,
  6. Stefano Catarci1,
  7. Mariano Ciancia1 and
  8. Gaetano Draisci1
  1. 1Anesthesia in Obstetrics, Gynaecology and Pain Therapy, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
  2. 2Dept. Anesthesiology, UZ Leuven, Leuven, Belgium
  3. 3Dept. of Anesthesiology, Brigham and Women’s Hospital, Boston, USA


Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission

Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)

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.

  • Dural puncture epidural analgesia
  • sacral analgesia
  • labor analgesia

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