-Original-

Effect of Dural Puncture Epidural Technique on Management of Breakthrough Pain for Parous Women Receiving Labor Analgesia during Induced Labor: A Retrospective Cohort Study

Youhei Tsunoda¹, Makoto Osumi², Takashi Matsushima³, Masashi Ishikawa⁴ and Shunji Suzuki¹

¹Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
²Department of Anesthesia, Higashitotsuka Memorial Hospital, Kanagawa, Japan
³Department of Obstetrics and Gynecology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
⁴Department of Anesthesia, Nippon Medical School Hospital, Tokyo, Japan

Background: This study assessed the effectiveness of the dural puncture epidural (DPE) technique in managing breakthrough pain in parous women receiving labor analgesia during induced labor.
Methods: This single-center retrospective cohort study included term pregnant women with singleton pregnancies who received treatment for breakthrough pain during labor. All participants underwent induced labor, and some parous women among them underwent DPE. The DPE technique consisted of placing an epidural catheter after dural puncture with a 27-gauge spinal needle. Eligible women were allocated into a DPE group and conventional epidural (CE) anesthesia group. Pain was assessed with a numerical rating scale (NRS), and a patient-controlled epidural analgesia (PCEA) bolus was administered when the NRS score was ≥3. Breakthrough pain was defined as an NRS score ≥3 during PCEA management. The primary outcome was the efficacy of rescue interventions in managing breakthrough pain, as determined by a reduction in pain intensity to an NRS score <3 before birth.
Results: Among the 55 parous women who received labor analgesia, 44 required additional rescue administration for breakthrough pain. Of the remaining women, 23 received DPE and 19 received CE anesthesia. The DPE group experienced significantly more effective relief of breakthrough pain before birth than did the CE group (DPE: 100%; CE: 68.4%; p=0.005).
Conclusion: In parous women, DPE anesthesia was more effective than CE anesthesia in providing analgesia for breakthrough pain immediately before delivery during induced labor.

J Nippon Med Sch 2024; 91: 426-431

Keywords
breakthrough pain, epidural anesthesia, analgesia

Correspondence to
Youhei Tsunoda, Department of Obstetrics and Gynecology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
y-tuno@nms.ac.jp

Received, March 17, 2024
Accepted, June 17, 2024