We are writing to raise some concerns about the study conducted by Tan et al. Their article “Quality of Labor Analgesia with Dural Puncture Epidural versus Standard Epidural Technique in Obese Parturients: A Double-blind Randomized Controlled Study” demonstrated that dural puncture epidural did not provide additional benefits in improving labor analgesia in obese parturients.

In their study, labor analgesia was maintained with programed intermittent epidural boluses of 6 ml of 0.1% ropivacaine with 2 µg/mL fentanyl every 45 min. With such small bolus volumes, the analgesic improvement resulting from drug translocation through the dural conduit with the dural puncture epidural technique may be obscured. Moreover, the delivery rate of programed bolus dose administration was not reported in this study. Generally, high-rate epidural boluses increase injectate pressure and might facilitate drug translocation. We speculated that the inadequate bolus volume and/or the low delivery rate failed to generate sufficient pressure gradient...

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