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Background <p>Dural puncture epidural (DPE) improves labor analgesia by reducing numeric rating scale (NRS) score, accelerating onset, and enhancing sacral blockade. Although larger-gauge needles may potentiate local anesthetic diffusion and improve analgesic quality, current clinical practice favors smaller-gauge needles (25-gauge to 27-gauge) to mitigate post-dural puncture headache (PDPH) risks. This randomized trial specifically evaluates the differential impacts of 23-gauge, 25-gauge, and 27-gauge needles on both analgesic efficacy and procedure-related complications.</p> Methods <p>In this randomized trial, 200 parturients requesting labor analgesia received DPE (23-gauge, 25-gauge, 27-gauge subgroups) or standard epidural (EP), followed by programmed intermittent epidural boluses (PIEB) of 12 mL with ropivacaine 0.08% and sufentanil 0.33&#xa0;µg/mL every 50&#xa0;min. Primary outcome was NRS score 10&#xa0;min after the initial epidural bolus; secondary outcomes included time to NRS score ≤ 1, block characteristics at 20&#xa0;min, number of top-up boluses, Apgar scores, and adverse events.</p> Results <p>Among 198 analyzed participants, all DPE groups exhibited lower 10-minute NRS scores versus EP groups (<i>P</i> &lt; 0.001). The 23-gauge and 25-gauge subgroups had lower NRS scores than 27-gauge (<i>P</i> &lt; 0.05), with no difference between 23-gauge and 25-gauge (<i>P</i> &gt; 0.05). The 23-gauge group achieved NRS score ≤ 1 fastest (<i>P</i> &lt; 0.001). DPE groups demonstrated higher bilateral sacral (S2) blockade rates versus EP groups (<i>P</i> &lt; 0.001), with no inter-subgroup differences. No significant difference were observed in procedure duration, top-up requirements, catheter adjustments/replacement, complications (PDPH, hypotension, nausea), or neonatal Apgar scores at 1 and 5&#xa0;min.</p> Conclusion <p>Compared to conventional epidural analgesia, the combined application of DPE and PIEB techniques demonstrated superior quality. The utilization of 25-gauge pencil-point spinal needles achieves the optimal balance between analgesic efficacy and safety, while the 23-gauge needle may be suitable for specific scenarios requiring rapid onset of action.</p>

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Dural puncture epidural technique with 23-, 25- or 27-gauge pencil point spinal needles versus standard epidural technique for labor analgesia: a randomized trial

  • 期刊论文

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  • 发表日期：

    2025年11月26日

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  • Zheng-bin Pan,
  • Jie-feng Chen,
  • Jie-lan Ding,
  • Zhi-min Sheng,
  • Hao Lv,
  • Zhong Mei,
  • Wei-wei Shui,
  • Yiyu Pan

摘要

Background

Dural puncture epidural (DPE) improves labor analgesia by reducing numeric rating scale (NRS) score, accelerating onset, and enhancing sacral blockade. Although larger-gauge needles may potentiate local anesthetic diffusion and improve analgesic quality, current clinical practice favors smaller-gauge needles (25-gauge to 27-gauge) to mitigate post-dural puncture headache (PDPH) risks. This randomized trial specifically evaluates the differential impacts of 23-gauge, 25-gauge, and 27-gauge needles on both analgesic efficacy and procedure-related complications.

Methods

In this randomized trial, 200 parturients requesting labor analgesia received DPE (23-gauge, 25-gauge, 27-gauge subgroups) or standard epidural (EP), followed by programmed intermittent epidural boluses (PIEB) of 12 mL with ropivacaine 0.08% and sufentanil 0.33 µg/mL every 50 min. Primary outcome was NRS score 10 min after the initial epidural bolus; secondary outcomes included time to NRS score ≤ 1, block characteristics at 20 min, number of top-up boluses, Apgar scores, and adverse events.

Results

Among 198 analyzed participants, all DPE groups exhibited lower 10-minute NRS scores versus EP groups (P < 0.001). The 23-gauge and 25-gauge subgroups had lower NRS scores than 27-gauge (P < 0.05), with no difference between 23-gauge and 25-gauge (P > 0.05). The 23-gauge group achieved NRS score ≤ 1 fastest (P < 0.001). DPE groups demonstrated higher bilateral sacral (S2) blockade rates versus EP groups (P < 0.001), with no inter-subgroup differences. No significant difference were observed in procedure duration, top-up requirements, catheter adjustments/replacement, complications (PDPH, hypotension, nausea), or neonatal Apgar scores at 1 and 5 min.

Conclusion

Compared to conventional epidural analgesia, the combined application of DPE and PIEB techniques demonstrated superior quality. The utilization of 25-gauge pencil-point spinal needles achieves the optimal balance between analgesic efficacy and safety, while the 23-gauge needle may be suitable for specific scenarios requiring rapid onset of action.