الفهرس 
Title : The impact of using different spinal needle sizes on the efficacy of the dural puncture epidural block. Comparative randomized controlled study
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Abstract
The combined spinal epidural technique (CSE) has been advocated over the conventional epidural technique for labor analgesia by several authors for the advantages of its rapid onset, profound analgesia and high patient satisfaction
However, the CSE technique has the potential of causing hemodynamic instability, fetal bradycardia and other side effects of intrathecally given local anesthetics and opioids.
In order to minimize these side effects while retaining the advantages, a novel method of dural puncture epidural (DPE) is suggested by several authors.
The dural puncture epidural (DPE) technique is a modification of the combined spinal epidural (CSE) technique, where a dural perforation is created from a spinal needle but intrathecal medication administration is withheld. It is performed by creating a single dural perforation via a spinal needle placed through the shaft of an epidural needle, followed by placement of a catheter into the epidural space. It creates a conduit for translocation of medications from the epidural to subarachnoid spaces, a process that is believed to be responsible for the unique characteristics that are observed with the DPE technique.
When compared with the conventional epidural technique, the DPE technique has been demonstrated to improve sacral block, onset and spread of anesthesia and analgesia; these properties are particularly advantageous in obstetric patients.
The current evidence regarding DPEA for labor analgesia remains unclear. New research should investigate the optimal (spinal) needle size for dural puncture.
Thus, in the current study, we compared traditional epidural technique versus Dural puncture epidural technique using either 25-gauge or 27-gauge pencil point spinal needles regarding the efficiency of the block and complications resulting from dural puncture as well.
Our findings suggest that although both techniques are efficacious for labor analgesia in primigravida, 25-G and 27-G Whitacre dural puncture epidural technique may benefit the nulliparous parturient more by improving the onset of analgesia and sacral spread compared to the conventional epidural technique.
That’s why we recommend the usage of 27G needle over 25G as both have the same efficacy, but the incidence of PDPH is lesser with the former.