Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences
Doi
Abstract
Background: Obese parturients are at higher risk for epidural analgesic failure, so the dural puncture epidural (DPE) technique may have particular advantage in this population. DPE has been suggested to improve the efficacy of labor epidural analgesia, potentially by facilitating the translocation of medication from the epidural to intrathecal space.
Objective:
We designed this prospective interventional study to explore the influence of obesity on DPE technique regarding labor analgesia onset and quality.
Methods:
Design: A prospective interventional study.
Patients:
64 parturients were consented to receive a DPE labor analgesia. Parturients were assigned according to pregestational body mass index groups into normal weight and obese groups. After successful placement of the epidural catheter and puncturing the dura, analgesic regimen was initiated.
Main outcome measure: The primary outcome was median time to onset of sensory block assessed by Kaplan-Meier analysis.
Results:
Using Kaplan-Meier curve, we found median time to onset of sensory block 6 min in obese parturients compared with 13 min in non obese. Difference between both groups was statistically significant (Logrank Chi-squared = 56.663, df = 1, p < 0.0001). Incidence rate ratio (95% CI) = 21.0 (9.51, 46.5). No asymmetrical block was noticed in both groups, but a higher incidence of perineal dose supplementation and postoperative nausea were observed in obese group
Conclusion:
DPE offers a favorable risk–benefit ratio for management of neuraxial analgesia in obese parturient. Further studies comparing different volume, concentration, method of application of DPE local anesthetic are needed
