Effect of Obesity on Dural Puncture Epidural Analgesic Onset in Parturients Scheduled for Normal Vaginal Delivery

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.