Dural Puncture Epidural Technique During Cesarean Section
Condition: Anesthesia, Obstetric
Study type: Interventional

Summary: 
      DPE technique was performed by creating a perforation in the dura mater using a pencil point
      spinal needle (25-27G) through the shaft of an epidural needle. After the dural perforation
      was created and the free flow of the cerebrospinal fluid (CSF) was confirmed, which was
      considered a definitive end point for the likely positioning of the epidural needle tip
      within the epidural space, and by avoiding direct intrathecal administration of medication
      making DPE technique of fewer adverse effects in comparison to CSE technique, then spinal
      needle was withdrawn without local anesthetic injection into the subarachnoid space and the
      epidural catheter was normally placed in the epidural space followed by injecting local
      anesthetics into the epidural space via the epidural catheter, where the dural puncture
      created a conduit for translocation of local anesthetics from the epidural space to the
      subarachnoid space which was a unique feature of DPE technique.

      Our study assessed the efficacy of DPE with pencil point spinal needle (25-27 G) during
      elective CS. Primary outcome was the onset time of surgical anesthesia which is defined as
      the time from the end of the initial dose injection to when the bilateral sensory block level
      reached the T6 dermatome. secondary outcomes were number of patients with cranial sensory
      block toT6 Level, number of patients with a modified bromage score reaching 3 at 15 min,
      intraoperative IV analgesia, local anesthetic volume, incidence of vasopressor administration
      and maternal &fetal complications.
    


Intervention name(s): Dural Puncture Epidural technique using pencil-point 25G Whitacre needle; Dural Puncture Epidural technique using pencil-point 27G Whitacre needle
Intervention type(s): Procedure; Procedure
Intervention description(s): - DPE technique was performed in the sitting position at the L3/4 or L4/5 interspace via the midline approach using a 17-gauge Touhy needle and a loss of resistance to saline technique, then the dura was punctured with a 25-gauge pencil point Whitacre spinal needles using a needle-through-needle technique, and spontaneous flow of cerebrospinal fluid was confirmed, then the spinal needle was removed and a flexible 19-gauge, spring closed-tip catheter was inserted 5 cm into the epidural space toward the cranial side.; - DPE technique was performed in the sitting position at the L3/4 or L4/5 interspace via the midline approach using a 17-gauge Touhy needle and a loss of resistance to saline technique, then the dura was punctured with a 27-gauage pencil point Whitacre spinal needles using a needle-through-needle technique, and spontaneous flow of cerebrospinal fluid was confirmed, then the spinal needle was removed and a flexible 19-gauge, spring closed-tip catheter was inserted 5 cm into the epidural space toward the cranial side.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Supportive Care