• XiaoPing Chen, YingYing Tang, QingQing Yu, LiHong Sun, Hua Li, LuYang Wang, Cuicui Jiao, and XinZhong Chen.
• From the Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China (XC, YT, QY, LS, HL, LW, CJ, XC).
• Eur J Anaesthesiol. 2025 Feb 1; 42 (2): 113121113-121.

BackgroundRapid onset of epidural analgesia is an important concern for the parturient. Commonly, the local anaesthetic mixture is administered through the epidural catheter. Drugs administered through the epidural needle might decrease the onset time and enhance the spread of medication within the epidural space.ObjectivesThe primary aim of this study was to compare the onset time of analgesia when a loading dose of dilute local anaesthetic opioid mixture was injected through either the Tuohy needle or a single end-hole epidural catheter.DesignA prospective, double-blinded, randomised clinical trial.SettingSingle university hospital, from November 2022 to August 2023.ParticipantsA total of 200 healthy nulliparous women who requested epidural analgesia for labour were randomly allocated to the needle group (n = 100) or the catheter group (n = 100).InterventionsIn the needle group, after identification of the epidural space, a test dose of 3 ml 0.1% ropivacaine with 0.3 μg ml-1 sufentanil was injected through the Tuohy needle followed 3 min later by a 15 ml loading dose of the same mixture over 30 s. Then the catheter was inserted into the epidural space. In the catheter group, after identification of the epidural space, a catheter was advanced into the epidural space and the ropivacaine/sufentanil mixture was injected in an identical manner though the catheter.Main Outcome MearsuresThe primary outcome was the onset time of labour analgesia (defined as the time from drug administration to adequate analgesia). Adequate analgesia was defined as a visual analogue score 10 mm or less during uterine contractions.ResultsMedian [IQR] onset time of labour analgesia did not differ significantly between the two groups (needle group: 20 [16 to 30] minutes; catheter group: 20 [15 to 25] minutes, P = 0.232).ConclusionCompared with bolus injection though a single end-hole epidural catheter, injection through the epidural needle did not shorten the analgesia onset time for adequate labour analgesia.Trial RegistrationClinicalTrials.gov (NCT05594771).Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology.

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