ArticleJournal of anesthesia2026
Comparison of labor duration between combined spinal-epidural analgesia and dural puncture epidural analgesia: a retrospective, observational study.
Article in Journal of anesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
purposeProlonged labor is associated with adverse maternal and neonatal outcomes. Combined spinal-epidural analgesia and dural puncture epidural analgesia are neuraxial analgesic techniques commonly used for labor pain relief. We aimed to compare labor duration between these two techniques.
methodsThis single-center, retrospective, observational study analyzed obstetric data of women who delivered using combined spinal-epidural or dural puncture epidural analgesia between January 2022 and November 2024. We used the inverse probability of treatment weighting method with combined spinal-epidural analgesia as the treatment group. The primary outcome was first-stage labor duration; secondary outcomes included second-stage labor duration, proportion of cesarean and instrumental deliveries, and neonatal outcomes. Time-to-event analysis was performed using the Kaplan-Meier method and Cox proportional hazards models.
resultsOf 1087 participants, 1011 were included (combined spinal-epidural analgesia, n = 845; dural puncture epidural analgesia, n = 166). After the inverse probability of treatment weighting adjustment, participant characteristics were well-balanced. First-stage labor duration did not significantly differ between groups (weighted hazard ratio, 1.14; 95% confidence interval [CI], 0.94-1.40; p = 0.187). However, combined spinal-epidural analgesia was associated with prolonged second-stage labor duration (weighted hazard ratio, 0.79; 95% CI, 0.65-0.96; p = 0.018) and lower cesarean delivery during the first stage (weighted odds ratio, 0.36; 95% CI, 0.22-0.61; p < 0.001). Other secondary outcomes were not significantly different between the groups.
conclusionFirst-stage labor duration was not significantly different between the two techniques. These results may inform clinical discussions about neuraxial analgesia selection in obstetric practice.
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