Randomized controlled trial found combined spinal-epidural improves analgesia in labor, suggesting enhanced effectiveness over dural puncture epidural.
( Anaesthesia . 2025;80:29–37. DOI: 10.1111/anae.16433) Both the combined spinal-epidural (CSE) and the dural puncture epidural (DPE) methods offer effective labor analgesia, and each has distinct procedures. In the CSE technique, after locating the epidural space, a spinal needle is inserted to inject medication directly into the cerebrospinal fluid before inserting the epidural catheter. In contrast, the DPE approach involves puncturing the dura with a spinal needle without administering medication intrathecally—analgesia is delivered solely through the epidural catheter. While both techniques are used, there are few studies directly comparing them. This study aimed to evaluate the quality of labor analgesia following initiation by either DPE or CSE.
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