Labor Analgesia Initiation With Dural Puncture Epidural Versus Conventional Epidural Techniques: A Randomized Biased-Coin Sequential Allocation Trial to Determine the Effective Dose for 90% of Patients of Bupivacaine

(Anesth Analg. 2023. doi: 10.1213/ANE.0000000000006691) Neuraxial labor analgesia includes the conventional epidural (EPL) technique as well as the combined spinal epidural and dural puncture epidural (DPE) techniques. Some advantages to the DPE technique have been discovered through research in comparison to the EPL technique. A study was conducted using a biased-coin up-down allocation method to determine the effective dose of bupivacaine needed to achieve initial analgesia in 90% of women in labor (ED90) using the DPE and EPL techniques. It was hypothesized that a lower bupivacaine dose would be needed with the DPE versus the EPL.