Retrospective analysis of combined spinal epidural analgesia and dural puncture epidural analgesia methods applied in obstetric analgesia

AIM: Childbirth is a physiological process that should be an easy and non-frightening experience for each woman, both psychologically and physically. This study aims to compare the methods of combined spinal epidural analgesia (Group CSE) and epidural analgesia with dural puncture (Group DPE) implemented in our clinic for labor analgesia. MATERIAL AND METHODS: After obtaining ethical committee approval for this retrospective study, data from all patients included in the routine labor analgesia protocol at our clinic between November 1, 2017, and November 1, 2023, were screened. From these files, demographic information, analgesia levels, obstetric details, and maternal-fetal outcomes were evaluated. Numeric Rating Scale (NRS, 0-10) scores used for pain level assessments in patients were recorded in both groups preoperatively, immediately after the procedure in patients undergoing combined spinal epidural analgesia (Group CSE), and 15 minutes after the procedure in patients undergoing epidural analgesia with dural puncture (Group DPE). Additionally, scores were documented at 30, 60, 120, 180, and 240 minutes post-procedure until the completion of labor for all patients. RESULTS: The study included a total of 111 patients, with 40 in Group CSE and 71 in Group DPE. Post-procedural pain levels were found to be lower in the CSE group compared to DPE, while at 120, 180, and 240 minutes, pain levels were lower in the DPE group. Cervical dilation was higher in the CSE group at 120 and 180 minutes. The total duration until delivery was longer in the DPE group. Demographic data, hemodynamic monitoring, effacement percentages, and newborn APGAR scores were similar between the two groups. CONCLUSION: The analgesic methods of DPE and CSE, applied in childbirth analgesia, have gained popularity in the frequency of use in comparison to the traditional epidural technique by shortening the onset of analgesia, reducing the need for additional analgesic doses, and minimizing undesired effects such as motor strength loss and itching. In this study, we observed that the CSE method provided faster analgesia compared to DPE, however, subsequent measurements revealed lower pain scores in the DPE group as opposed to CSE. We determined that both groups yielded similar outcomes in terms of maternal and fetal effects. We believe further supplementary studies are necessary to support these results.