Effect of Obesity on Dural Puncture Epidural Analgesic Onset in Parturients Scheduled for Normal Vaginal Delivery
Journal of Cellular & Molecular Anesthesia,
Vol. 8 No. 1 (2023),
6 January 2023
,
Page 31-39
https://doi.org/10.22037/jcma.v8i1.39134
Abstract
Background: Obese parturients are at higher risk for epidural analgesic failure, so the dural puncture epidural (DPE) technique may have a 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 the intrathecal space. We designed this prospective interventional study to explore the influence of obesity on DPE technique regarding labor analgesia onset and quality.
Materials and Methods: The study was prospective interventional. A total of 64 parturients consented to receive DPE labor analgesia. Parturients were assigned according to pregestational body mass index groups into normal weight and obese groups. After the successful placement of the epidural catheter and puncturing of the dura, an analgesic regimen was initiated. The primary outcome was the median time to onset of sensory block assessed by Kaplan-Meier analysis.
Results: We found the median time to onset of sensory block to be 6 min in obese parturients compared with 13 min in nonobese. The difference between both groups was statistically significant (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 group, but a higher incidence of perineal dose supplementation and postoperative nausea were observed in the obese group.
Conclusion: DPE offers a favorable risk-benefit ratio for the management of neuraxial analgesia in obese parturients. Further studies comparing different volumes, concentrations, and methods of application of DPE local anesthetic are needed.
- Body Mass Index
- Combined Spinal Epidural
- Dural Puncture Epidural
- Maternal Satisfaction
- Labor Pain
- Obesity
How to Cite
References
Nani FS, Torres ML. Correlation between the body mass index (BMI) of pregnant women and the development of hypotension after spinal anesthesia for cesarean section. Rev Bras Anestesiol. 2011;61(1):21-30.
Eley VA, van Zundert A, Callaway L. What is the failure rate in extending labour analgesia in patients with a body mass index ≥ 40 kg/m(2)compared with patients with a body mass index < 30 kg/m(2)? a retrospective pilot study. BMC Anesthesiol. 2015;15:115.
Saravanakumar K, Rao SG, Cooper GM. Obesity and obstetric anaesthesia. Anaesthesia. 2006;61(1):36-48.
Chau A, Bibbo C, Huang CC, Elterman KG, Cappiello EC, Robinson JN, et al. Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques: A Randomized Clinical Trial. Anesth Analg. 2017;124(2):560-9.
Collis RE, Davies DW, Aveling W. Randomised comparison of combined spinal-epidural and standard epidural analgesia in labour. Lancet. 1995;345(8962):1413-6.
Taylor CR, Dominguez JE, Habib AS. Obesity And Obstetric Anesthesia: Current Insights. Local Reg Anesth. 2019;12:111-24.
Butwick AJ, Wong CA, Guo N. Maternal Body Mass Index and Use of Labor Neuraxial Analgesia: A Population-based Retrospective Cohort Study. Anesthesiology. 2018;129(3):448-58.
Plaat F, Stanford SER, Lucas DN, Andrade J, Careless J, Russell R, et al. Prevention and management of intra-operative pain during caesarean section under neuraxial anaesthesia: a technical and interpersonal approach. Anaesthesia. 2022;77(5):588-97.
Srivastava U, Pilendran S, Dwivedi Y, Shukla V. Radiographic evidence of unilateral epidural anesthesia. J Anaesthesiol Clin Pharmacol. 2013;29(4):571-2.
Dresner M, Brocklesby J, Bamber J. Audit of the influence of body mass index on the performance of epidural analgesia in labour and the subsequent mode of delivery. BJOG. 2006;113(10):1178-81.
Heesen M, Rijs K, Rossaint R, Klimek M. Dural puncture epidural versus conventional epidural block for labor analgesia: a systematic review of randomized controlled trials. Int J Obstet Anesth. 2019;40:24-31.
Lamon AM, Habib AS. Managing anesthesia for cesarean section in obese patients: current perspectives. Local Reg Anesth. 2016;9:45-57.
Panni MK, Columb MO. Obese parturients have lower epidural local anaesthetic requirements for analgesia in labour. Br J Anaesth. 2006;96(1):106-10.
Tan HS, Reed SE, Mehdiratta JE, Diomede OI, Landreth R, Gatta LA, et al. Quality of Labor Analgesia with Dural Puncture Epidural versus Standard Epidural Technique in Obese Parturients: A Double-blind Randomized Controlled Study. Anesthesiology. 2022;136(5):678-87.
Arendt K, Segal S. Why epidurals do not always work. Rev Obstet Gynecol. 2008;1(2):49-55.
Wang SY, He Y, Zhu HJ, Han B. Dural puncture epidural technique provides better anesthesia quality in repeat cesarean delivery than epidural technique: Randomized controlled study. World J Clin Cases. 2022;10(20):6890-9.
Song Y, Du W, Zhou S, Zhou Y, Yu Y, Xu Z, et al. Effect of Dural Puncture Epidural Technique Combined With Programmed Intermittent Epidural Bolus on Labor Analgesia Onset and Maintenance: A Randomized Controlled Trial. Anesth Analg. 2021;132(4):971-8.
Vosoughian M, Dahi-Taleghani M, Moshari MR, Rajaei S, Rajabi S, Taheri F. The Effect of Spinal and General Anesthesia on Cytokine Serum Levels Following Cesarean Section in Preeclampsia. J Cell Mol Anesth. 2018;3(3):89-97.
Stagg P. Integrating ultrasound with the combined spinal-epidural kit as a rescue technique during difficult spinal anaesthesia. BMJ Case Rep. 2021;14(11).
Patel SD, Habib AS. Anaesthesia for the parturient with obesity. BJA Educ. 2021;21(5):180-6.
González-Tascón CC, Díaz EG, García IL. Epidural analgesia in the obese obstetric patient: a retrospective and comparative study with non-obese patients at a tertiary hospital. Braz J Anesthesiol. 2021;71(3):214-20.
Uyl N, de Jonge E, Uyl-de Groot C, van der Marel C, Duvekot J. Difficult epidural placement in obese and non-obese pregnant women: a systematic review and meta-analysis. Int J Obstet Anesth. 2019;40:52-61.
Kula AO, Riess ML, Ellinas EH. Increasing body mass index predicts increasing difficulty, failure rate, and time to discovery of failure of epidural anesthesia in laboring patients. J Clin Anesth. 2017;37:154-8.
Okifuji A, Hare BD. The association between chronic pain and obesity. J Pain Res. 2015;8:399-408.
Kim JH, Hong M, Kim YJ, Lee HS, Kwon YS, Lee JJ. Effect of Body Mass Index on Postoperative Nausea and Vomiting: Propensity Analysis. J Clin Med. 2020;9(6).
Balki M, Carvalho JC. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. Int J Obstet Anesth. 2005;14(3):230-41.
- Abstract Viewed: 153 times
- PDF Downloaded: 166 times