Clinical Indications for the Dural Puncture Epidural Technique

By May 28, 2019Uncategorized

Neuraxial Anesthesia, and more specifically epidural anesthesia, is the most common method of pain control for laboring obstetric patients. Its popularity stems from the fact that it is extremely effective, has a relatively low risk profile, and has few absolute contraindications. In addition, the American College of Obstetricians and Gynecologists (ACOG) and the American Society of Anesthesiologists (ASA) agree that a patient without contraindications (blood-thinning medication, for example) can request an epidural at any stage of labor and safely receive one.

Modifications to the standard epidural have grown in popularity in recent years. For example, combined spinal-epidurals (CSE) are sometimes used in place of a standard epidural for both laboring patients as well as patients going to Cesarean section whose procedures may take an extended amount of time. To perform a CSE, the practitioner obtains loss of resistance (similar to an epidural), and then inserts a spinal needle through the epidural needle that pierces through the dura. Once the practitioner confirms CSF return, they will inject local anesthetic into the intrathecal space. This is followed by placement of an epidural catheter into the epidural space, which can be used to infuse local anesthesia.  Compared to an epidural, multiple studies show that a CSE provides more rapid onset of pain relief, and more reliable, symmetrical, and improved sacral pain control t