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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2026, Vol. 22 ›› Issue (03): 267 -277. doi: 10.3877/cma.j.issn.1673-5250.2026.03.010

Original Article

Clinical efficacy and safety of dural puncture epidural for labor analgesia

Hui Xu1, Kun Han2, Mintao Wan3,†()   

  1. 1Department of Anesthesiology, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
    2Department of Anesthesiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
    3Department of Anesthesiology, Wanyuan People′s Hospital, Dazhou 636350, Sichuan Province, China
  • Received:2026-04-08 Revised:2026-05-10 Published:2026-06-01
  • Corresponding author: Mintao Wan
  • Supported by:
    Key Research and Development Projects of Science and Technology Plans of Dazhou(22ZDYF0032)
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Objective

To investigate the analgesic efficacy, block characteristics, and adverse reactions of dural puncture epidural (DPE) for labor analgesia.

Methods

A total of 135 parturients with singleton pregnancies who entered labor and planned to receive neuraxial labor analgesia at Wanyuan People′s Hospital from June 1 to December 31, 2025 were selected into this study. They were assigned to DPE group (n=43), epidural analgesia (EP) group (n=47) and combined spinal-epidural analgesia (CSE) group (n=45) using a random number table method. The following outcomes were compared among the three groups: uterine contraction parameters during six consecutive contractions after drug administration, including uterine contraction pressure, contraction duration, and contraction interval; visual analogue scale (VAS) scores and lower-limb motor block, assessed by the modified Bromage score, at 5, 10, 20, and 30 min after analgesia; the number of effective patient-controlled epidural analgesia (PCEA) bolus attempts, duration of analgesia, total consumption of analgesic solution, duration of labor stages, anesthesia and obstetric interventions, maternal satisfaction score, labor analgesia-related adverse events, neonatal Apgar scores, and arterial blood gas analysis results. The procedures of this study complied with the regulations of the Medical Ethics Committee of Wanyuan People′s Hospital and were approved by the committee (Approval No. LLSC-KY-202201). All participants signed informed consent forms for trial of vaginal delivery, neuraxial labor analgesia, and participation in this clinical study.

Results

①There were no statistically significant differences in general characteristics, including maternal age, body weight, and height, among the three groups (P>0.05). ② In terms of analgesic efficacy, there were statistically significant differences in the overall comparison of VAS scores among the three groups at 5, 10, 20, and 30 min after analgesia (P<0.05). Further pairwise comparisons showed that, at each time point, VAS scores in the CSE group were lower than those in the EP and DPE groups, and VAS scores in the DPE group were lower than those in the EP group, with statistically significant differences (P<0.017). ③In terms of uterine contraction-related parameters, there were statistically significant differences in the overall comparisons of the 3rd, 5th, and 6th uterine contraction pressures and the 1st and 3rd uterine contraction intervals after drug administration among the three groups (P<0.05). Further pairwise comparisons showed that the 3rd and 6th uterine contraction pressures were lower in the CSE group than those in the EP and DPE groups; the 5th uterine contraction pressure was higher in the DPE group than that in the EP and CSE groups; the 1st uterine contraction interval was shorter in the CSE group than that in the EP and DPE groups; and the 3rd uterine contraction interval was longer in the DPE group than that in the EP and CSE groups, with statistically significant differences (P<0.017). There were no statistically significant differences in the overall comparisons of the durations of six consecutive uterine contractions among the three groups (P>0.05). ④In terms of labor analgesia-related parameters and labor duration, there were no statistically significant differences in the number of effective PCEA bolus attempts, duration of analgesia, total consumption of analgesic solution, or durations of the first, second, and third stages of labor among the three groups (P>0.05). ⑤In terms of lower-limb motor block, the modified Bromage scores in the CSE group were higher than those in the EP and DPE groups at 5 and 10 min after analgesia, and higher than those in the EP group at 20 min after analgesia, with statistically significant differences (P<0.017). ⑥In terms of adverse events and interventions, there were no statistically significant differences in the incidences of maternal hypotension, fever, pruritus, or anesthesia intervention among the three groups (P>0.05). There were statistically significant differences in the overall comparisons of the incidence of fetal heart rate abnormalities and the rate of obstetric intervention (P<0.05); however, further pairwise comparisons showed no statistically significant differences (P>0.017). ⑦There were no statistically significant differences in maternal satisfaction scores, neonatal Apgar scores at 1, 5, and 10 min after birth, or arterial blood gas analysis results among the three groups (P>0.05).

Conclusions

DPE for labor analgesia can improve the early analgesic efficacy of EP and is associated with less early lower-limb motor block than CSE, without increasing the risk of maternal and neonatal adverse events. DPE has certain advantages in analgesic efficacy, preservation of motor function, and maternal and neonatal safety, and may provide a reference for the selection of neuraxial labor analgesia techniques.

Key words: Labor analgesia, Dural puncture epidural, Epidural analgesia, Combined spinal-epidural analgesia, Visual analogue scale, Modified Bromage score, Uterine contraction, Adverse reactions, Pregnant women
表1 本研究3组产妇一般资料及椎管内操作前相关指标比较(±s)
组别 例数 年龄(岁) 体重(kg) 身高(cm) 收缩压(mmHg) 舒张压(mmHg) 心率(次/min)
DPE组 43 25.7±4.0 68.4±8.4 158.1±4.1 121.9±9.0 77.0±6.5 86.1±11.0
EP组 47 25.9±3.4 68.7±7.6 159.1±4.5 122.6±11.7 78.4±9.3 87.6±11.4
CSE组 45 26.3±3.4 68.0±8.6 159.1±4.1 119.9±12.4 76.2±7.0 84.2±12.0
F值   0.29 0.07 0.66 0.66 0.91 1.02
P值   0.743 0.930 0.517 0.517 0.403 0.363
组别 例数 SpO2(%) 胎心率(次/min) 分娩镇痛前宫缩情况
VAS评分(分) 宫缩压力(mmHg) 宫缩持续时间(s) 宫缩间隔时间(min)
DPE组 43 98.1±1.7 142.8±11.5 81.3±14.1 70.0±2.4 37.3±1.9 3.2±0.1
EP组 47 98.4±0.9 143.9±9.5 82.8±13.8 69.8±2.7 37.6±1.7 3.2±0.2
CSE组 45 98.4±0.8 143.1±9.1 80.0±14.9 70.4±2.1 37.6±1.8 3.3±0.2
F值   1.09 0.13 0.43 0.81 0.51 0.24
P值   0.339 0.875 0.650 0.444 0.601 0.786
表2 本研究3组产妇给药后连续6次宫缩压力比较(mmHg)
组别 例数 第1次(±s) 第2次(±s) 第3次[M(Q1，Q3)] 第4次(±s) 第5次[M(Q1，Q3)] 第6次[M(Q1，Q3)]
DPE组 43 94.6±8.1 94.7±8.5 94(91，97) 93.7±9.2 97(94，99) 96(94，99)
EP组 47 95.1±8.7 95.4±8.9 95(92，97) 94.0±9.9 93(91，96) 94(92，97)
CSE组 45 95.8±8.6 95.7±9.3 88(85，91) 90.1±11.9 91(88，94) 91(88，93)
总体比较              
统计量   F＝0.19 F＝0.13 H＝13.20 F＝1.94 H＝10.56 H＝11.98
P值   0.823 0.876 0.001 0.147 0.005 0.003
EP组vs CSE组              
Z值   — — 4.52 — 1.20 3.20
P值   — — <0.001 — 0.230 0.001
DPE组vs EP组              
Z值   — — 0.65 — 2.95 1.50
P值   — — 0.520 — 0.008 0.134
DPE组vs CSE组              
Z值   — — 3.68 — 4.02 4.36
P值   — — 0.002 — <0.001 <0.001
表3 本研究3组产妇给药后连续6次宫缩持续时间比较(s, ±s)
组别 例数 第1次 第2次 第3次 第4次 第5次 第6次
DPE组 43 36.9±4.7 38.1±4.7 37.3±4.2 36.9±3.9 37.3±4.9 37.1±4.5
EP组 47 37.1±4.1 37.9±4.6 36.9±4.8 36.4±4.9 37.4±4.6 38.1±4.9
CSE组 45 36.7±4.5 37.6±4.6 37.3±5.3 36.2±4.7 37.2±4.3 37.0±4.6
F值 0.10 0.16 0.08 0.25 0.01 0.72
P值   0.905 0.847 0.917 0.777 0.985 0.484
表4 本研究3组产妇给药后连续6次宫缩间隔时间比较(min, ±s)
组别 例数 第1次 第2次 第3次 第4次 第5次 第6次
DPE组 43 2.6±0.3 2.5±0.3 2.6±0.3 2.5±0.3 2.4±0.3 2.4±0.3
EP组 47 2.5±0.3 2.5±0.4 2.4±0.3 2.4±0.3 2.5±0.3 2.5±0.3
CSE组 45 2.3±0.3 2.4±0.3 2.4±0.3 2.5±0.3 2.5±0.3 2.5±0.3
总体比较(F值/P值)   10.20/<0.001 0.80/0.450 8.00/<0.001 1.44/0.239 0.49/0.611 1.53/0.220
EP组vs CSE组(t值/P值)   3.19/0.001 — <0.001/>0.999 — — —
EP组vs DPE组(t值/P值)   1.58/0.118 — 3.16/0.006 — — —
CSE组vs DPE组(t值/P值)   4.69/<0.001 — 3.16/0.006 — — —
表5 本研究3组产妇分娩镇痛后不同时间点VAS评分比较[分，M(Q1，Q3)]
组别 例数 镇痛后5 min 镇痛后10 min 镇痛后20 min 镇痛后30 min
DPE组 43 45(42，47) 28(25，30) 18(16，20) 18(16，20)
EP组 47 59(55，62) 35(31，38) 25(23，27) 21(18，23)
CSE组 45 24(21，27) 14(12，16) 11(10，12) 12(10，13)
总体比较(H值/P值)   85.20/<0.001 70.50/<0.001 67.11/<0.001 22.84/<0.001
EP组vs CSE组(Z值/P值)   8.15/<0.001 7.88/<0.001 7.65/<0.001 6.35/<0.001
DPE组vs EP组(Z值/P值)   4.85/<0.001 4.21/<0.001 4.56/<0.001 3.20/0.001
DPE组vs CSE组(Z值/P值)   6.95/<0.001 6.51/<0.001 6.22/<0.001 5.11/<0.001
表6 本研究3组产妇分娩镇痛相关指标及第一、第二、第三产程时长比较
组别 例数 PCEA有效按压次数[次，M(Q1，Q3)] 镇痛时长[min，M(Q1，Q3)] 镇痛药液使用总量[mL，M(Q1，Q3)] 第一产程时长(min，±s) 第二产程时长(min，±s) 第三产程时长(min，±s)
DPE组 43 0(0，1) 341(284，399) 52(43，60) 588.9±119.2 90.3±31.3 15.1±5.9
EP组 47 0(0，1) 358(285，432) 53(43，63) 607.5±141.9 95.3±25.9 16.0±6.3
CSE组 45 0(0，1) 352(289，415) 49(39，58) 600.0±127.7 92.5±26.2 14.8±6.1
统计量   H＝5.86 H＝0.07 H＝0.23 F＝0.21 F＝0.32 F＝0.41
P值   0.053 0.929 0.794 0.810 0.721 0.659
表7 本研究3组产妇分娩镇痛后不同时间点改良Bromage评分比较[分，M(Q1，Q3)]
组别 例数 镇痛后5 min 镇痛后10 min 镇痛后20 min 镇痛后30 min
DPE组 43 0(0，0) 0(0，0) 0(0，0) 0(0，1)
EP组 47 0(0，0) 0(0，0) 0(0，0) 0(0，1)
CSE组 45 0(0，1) 1(0，1) 1(0，1) 1(0，2)
总体比较(H值/P值)   8.20/0.017 15.60/<0.001 22.30/<0.001 4.50/0.105
EP组vs CSE组(Z值/P值)   2.26/0.012 3.95/<0.001 4.72/<0.001 —
DPE组vs EP组(Z值/P值)   <0.001/>0.999 <0.001/>0.999 2.14/0.032 —
DPE组vs CSE组(Z值/P值)   2.25/0.012 3.95/<0.001 2.58/0.030 —
表8 本研究3组产妇分娩镇痛相关干预率及满意度评分比较
组别 例数 麻醉干预率[例数(%)] 产科干预率[例数(%)] 满意度评分(分，±s)
DPE组 43 4(9.3) 1(2.3) 96.0±5.0
EP组 47 14(29.8) 3(6.4) 96.0±4.0
CSE组 45 9(20.0) 8(17.8) 95.6±5.2
统计量   χ2＝5.89 —a F＝0.08
P值   0.053 0.030 0.919
表9 本研究3组产妇新生儿生后Apgar评分及脐动脉血气分析结果比较(±s)
组别 例数 生后Apgar评分(分) pH值 PaO2(mmHg) PaCO2(mmHg)
生后1 min 生后5 min 生后10 min
DPE组 43 8.5±0.9 9.5±0.7 9.9±0.4 7.3±0.1 65.0±5.3 39.5±4.9
EP组 47 8.6±0.7 9.5±0.6 10.0±0.0 7.3±0.1 66.7±5.7 39.0±4.8
CSE组 45 8.8±0.7 9.7±0.5 9.9±0.3 7.3±0.1 66.8±5.5 40.4±4.4
F值   2.10 1.15 1.20 0.04 1.36 0.87
P值   0.127 0.319 0.303 0.957 0.259 0.420
表10 本研究3组产妇分娩镇痛相关不良反应及胎心异常发生率比较[例数(%)]
组别 例数 低血压 发热 瘙痒 胎心异常
DPE组 43 5(11.6) 4(9.3) 1(2.3) 2(4.7)
EP组 47 5(10.6) 6(12.8) 0(0) 2(4.3)
CSE组 45 9(20.0) 5(11.1) 3(6.7) 8(17.8)
χ2值   1.98 0.27 —a —a
P值   0.372 0.872 0.250 0.049
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