Dural puncture epidural analgesia versus conventional epidural analgesia combined with programmed intermittent epidural bolus for labor analgesia: a prospective randomized controlled trial

Effective labor analgesia must balance rapid onset, sustained pain relief, and maternal safety. Conventional epidural analgesia (EP) often produces uneven sensory block and breakthrough pain during prolonged labor. Dural puncture epidural analgesia (DPE), by creating a microperforation of the dura, may enhance the spread of local anesthetic and improve block quality. In this prospective randomized controlled trial, 79 healthy parturients in active labor were assigned to receive DPE combined with programmed intermittent epidural bolus (PIEB) (n = 40) or EP combined with PIEB (n = 39). After epidural catheter placement in the L3–4 interspace, both groups received an initial 13 mL injection of 0.1% ropivacaine and 0.5 μg/mL sufentanil, followed by PIEB maintenance therapy. The primary outcome was onset of analgesia (time from initial bolus to numeric rating scale [NRS] ≤ 3). Secondary outcomes included duration of effective analgesia, number of breakthrough-pain episodes, maternal hemodynamics, Bromage motor scores, neonatal Apgar scores, and adverse events. The DPE group achieved faster onset (9.9 ± 4.1 min vs 14.3 ± 5.7 min, p < 0.001), longer effective analgesia (9.5 ± 2.2 h vs 7.8 ± 2.3 h, p < 0.001), and a trend toward fewer breakthrough-pain episodes (median [IQR]: 0 [0–0] vs 0 [0–1], p = 0.169). Maternal satisfaction scores were higher in the DPE group (9.1 ± 0.9 vs 8.2 ± 1.2, p = 0.002). Hemodynamic parameters and incidence of hypotension, nausea, or motor block were similar between groups. No significant differences were observed in neonatal Apgar scores. Compared with conventional epidural analgesia, DPE combined with PIEB provides faster onset, longer duration, and more stable labor analgesia, although the trend toward fewer breakthrough-pain episodes did not reach statistical significance, and without increased adverse effects. This technique offers an optimized balance between analgesic efficacy and maternal safety and may serve as a promising alternative for modern obstetric analgesia that warrants further validation in larger multicenter trials. Trial registration: Chinese Clinical Trial Registry, registration number: ChiCTR2500103987; date of registration: 09th June 2025.