Abstract
BACKGROUND: Dural puncture epidural (DPE) is a newer and more advantageous method in labor analgesia. It provides a faster analgesia onset and higher-quality block compared to the conventional epidural (CE) method, while causing fewer adverse effects than the combined spinal-epidural (CSE) technique. This study aims to compare the effects of bupivacaine at different concentrations, but equal volumes administered via DPE on the mother, fetus, and labor process, and reduce total bupivacaine requirement and its potential side effects. METHODS: Seventy ASA II primigravid pregnant women with cervical dilatation between 4 and 6 cm were included in the study. Participants were randomly divided into two groups. Group 1 received a high concentration of bupivacaine (0.125%) + 2 mcg/mL fentanyl; Group 2 received a low concentration of bupivacaine (0.0625%) + 2 mcg/mL fentanyl, both using DPE. The numeric rating scale (NRS) score was aimed to be < 4. The total amount of bupivacaine and fentanyl administered through the epidural catheter, the time between applications, the time between applications and birth, the number of doses administered, complications, maternal vital signs, fetal heart rate and maternal satisfaction were recorded. RESULTS: The mean amount of bupivacaine administered was 31.7 ± 7.6 mg in Group 1 and 15.1 ± 3.4 mg in Group 2, showing a significant difference (P = 0.001, Mean ± SD, Student's t test). There were no significant differences in NRS scores, duration between doses, duration between doses and delivery, satisfaction, and complications. CONCLUSION: This study compared the effects of different bupivacaine concentrations with DPE and found that using low-concentration bupivacaine (0.0625%) for labor provides adequate analgesia without increasing complications or delivery time while reducing the amount of bupivacaine needed. TRIAL REGISTRATION: Registration number: NCT05499234. Registration date: 2022-08-02 (Retrospectively registered). Registration URL: https://clinicaltrials.gov/ct2/show/NCT05499234 .