Combined Implementation of Dural Puncture Epidural and Programmed Intermittent Epidural Bolus for Labor Analgesia
Condition: Labor Pain; Labor Analgesia
MeSH terms: Labor Pain
Study type: Interventional

Summary: 
      This study intends to carry out a prospective, randomized double-blind study to evaluate the
      safety and efficacy of the combined implementation of Dural puncture epidural (DPE) technique
      and Programmed intermittent epidural bolus (PIEB) for labor analgesia.
    

Detailed description: 
      Epidural (EPL) technique is the standard technique for labor analgesia, but can be associated
      with slow onset and inadequate sacral spread, unilateral or patchy sensory blockade, motor
      impairment. The combined spinal epidural (CSE) technique can provide rapid onset of
      analgesia, but is associated with greater side effects, including pruritus, fetal bradycardia
      and delayed testing of epidural catheters. Dural puncture epidural (DPE) technique is a
      modification of CSE technique. A spinal needle is introduced through the epidural needle to
      create a single dural puncture , after intrathecal space was identified by the free flow of
      cerebrospinal fluid (CSF) , the needle was removed without direct medication administration
      into the subarachnoid space. Privous studies have demonstrated that the DPE technique can
      improve block quality over the EPL technique with fewer maternal and fetal side effects than
      the CSE technique for parturients requesting labor analgesia. Besides the neuraxial
      techniques, maintenance regimens is another factor that affect the analgesic effect.
      Programmed intermittent epidural bolus (PIEB) provides greater spread of local anesthetic
      solution within the epidural space and therefore superior quality of analgesia compared with
      continuous epidural infusion (CEI). We designed this prospective randomized, double-blind
      study to evaluate the safety and efficacy of the combined implementation of DPE technique and
      PIEB for labor analgesia.
    

Intervention name(s): EPL and CEI; DPE and CEI; DPE and PIEB
Intervention type(s): Other; Other; Other
Intervention description(s): Procedure: Standard epidural placement(EPL)
Drug: ropivacaine Drug: sufentani 0.1% ropivacaine + sufentanil 0.3μg/mL
Device: Infusion pump Infusion pump set to continuous epidural infusion(CEI) plus patient-controlled epidural analgesia (PCEA).; Procedure: Dural puncture epidural (DPE) Epidural with spinal needle placed to create a single dural puncture and confirm free flow of cerebral spinal fluid (CSF) , without direct medication administration into the subarachnoid space.
Drug: ropivacaine Drug: sufentani 0.1% ropivacaine + sufentanil 0.3μg/mL
Device: Infusion pump Infusion pump set to continuous epidural infusion(CEI) plus patient-controlled epidural analgesia (PCEA).; Procedure: Dural puncture epidural (DPE) Epidural with spinal needle placed to create a single dural puncture and confirm free flow of cerebral spinal fluid (CSF) , without direct medication administration into the subarachnoid space.
Drug: ropivacaine Drug: sufentani 0.1% ropivacaine + sufentanil 0.3μg/mL
Device: Infusion pump Infusion pump set to programmed intermittent epidural boluses (PIEB) plus patient-controlled epidural analgesia (PCEA).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: labor analgesia; dural puncture epidural (DPE); standard Epidural (EPL); continuous epidural infusion (CEI); programmed intermittent epidural bolus (PIEB)