# Effect of dural puncture epidural combined with programmed intermittent epidural bolus on labor analgesia in patients with gestational hypertension: a randomized controlled clinical trial

## TL;DR

This study found that combining dural puncture epidural with programmed intermittent epidural bolus improves labor pain relief for women with gestational hypertension without harming mothers or babies.

## Contribution

The study introduces a new combined epidural technique that improves analgesia onset and hemodynamic stability in gestational hypertension patients.

## Key findings

- DPE–PIEB shortened analgesia onset by ~4 minutes compared to EP–PIEB.
- DPE–PIEB reduced breakthrough pain and PCEA use while maintaining stable blood pressure.
- Maternal satisfaction was higher with DPE–PIEB and no neonatal risks were observed.

## Abstract

Hypertensive disorders of pregnancy affect 5–10% of pregnancies and require the maintenance of hemodynamic stability while providing effective labor analgesia. This study compared the efficacy and safety of dural puncture epidural (DPE) block combined with programmed intermittent epidural bolus (PIEB) versus conventional epidural (EP) block in labor analgesia for patients with gestational hypertension (GH).

Between January and March 2025, 98 primiparous women with GH and singleton pregnancies who requested neuraxial analgesia were randomized to receive either DPE–PIEB (Group D, n = 49) or EP–PIEB (Group E, n = 49). The primary outcome was time to effective analgesic onset (defined as Visual Analog Scale score≤30 mm). Secondary outcomes included hemodynamic stability, patient-controlled epidural analgesia (PCEA) use, incidence of breakthrough pain, maternal and infant outcomes, and adverse events.

Compared with EP–PIEB, patients receiving DPE–PIEB had a shorter onset of analgesia (6.05 ± 1.08 vs. 9.75 ± 1.3 min, p < 0.001), a longer time to first PCEA request (144.33 ± 17.18 vs. 116.58 ± 14.03 min, p < 0.001), fewer PCEA demands (2.78 ± 0.83 vs. 4.53 ± 1.26, p < 0.001), and had a lower incidence of breakthrough pain (9.1% vs. 25%, p < 0.05). The repeated measures ANOVA demonstrated that patients in Group D maintained lower and more consistent Mean arterial pressure (MAP) values throughout labor. MAP values were significantly lower at time points T1, T3, T4, and T5 in the DPE–PIEB group (p < 0.05), and maternal satisfaction scores were higher (9.39 ± 0.75 vs. 9.02 ± 0.76, p < 0.05). No significant between-group differences were found in neonatal outcomes (Apgar score, umbilical artery pH) or the incidence of adverse events between the two groups (p > 0.05).

DPE–PIEB can significantly shorten the onset of labor analgesia in patients with GH, reduce hemodynamic fluctuations and breakthrough pain, and improve maternal satisfaction, without increasing maternal or neonatal risks. This combined technique provides a more optimized analgesic strategy and can be safely and effectively implemented in labor analgesia for patients with GH.

Identifier ChiCTR2400095084 (www.chictr.org.cn).