Application efficacy of dural puncture epidural versus traditional combined spinal epidural for labour analgesia: A systematic review and meta-analysis with trial sequential analysis.

Abstract

<h4>Background and aims</h4>This study aimed to systematically evaluate the effectiveness and safety of dural puncture epidural (DPE) and combined spinal epidural (CSE) for labour analgesia in parturients.<h4>Methods</h4>Searches were performed in PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, VIP Database, and CBM Database up to June 2025 to identify randomised controlled trials (RCTs) investigating the application of DPE and CSE techniques for labour analgesia in parturients. Data from eligible studies were pooled to calculate the combined standardised mean difference (SMD) or risk ratio (RR).<h4>Results</h4>Eleven studies with 1461 parturients were included. DPE had higher visual analogue scale (VAS) pain scores at 10 min [SMD: 0.60; 95% confidence interval (CI): 0.24, 0.95; <i>P</i> = 0.001; <i>I</i> ² <i>=</i> 76%] compared to CSE but fewer parturients requiring physician top-up boluses (RR = 0.64; 95% CI: 0.46, 0.88; <i>P</i> = 0.006; <i>I</i> ² <i>=</i> 11%). It also showed significantly lower incidences of abnormal foetal heart rate patterns (RR = 0.27; 95% CI: 0.16, 0.44; <i>P</i> < 0.001; <i>I</i> ² <i>=</i> 0%), pruritus (RR = 0.27; 95% CI: 0.14, 0.53; <i>P</i> < 0.001; <i>I</i> ² <i>=</i> 54%), and maternal hypotension (RR = 0.36; 95% CI: 0.15, 0.89; <i>P</i> = 0.030; <i>I</i> ² <i>=</i> 74%). No significant intergroup differences were found in first-stage labour duration, neonatal Apgar scores, or adverse reactions. The trial sequential analysis suggested the need for further data.<h4>Conclusion</h4>Compared with CSE, although DPE has a slower onset of analgesia, it may provide more reliable analgesic effects and result in lower incidence rates of adverse reactions in both parturients and foetuses. Substantial heterogeneity in some outcomes, driven by clinical heterogeneity including dose variations and limited studies, warrants cautious interpretation.