The Effectiveness and Safety of Dural Puncture Epidural for Aged Patients Undergoing Orthopedic Surgery: A Randomized Controlled Trial

Objective: The dural puncture epidural (DPE) technique is a novel approach for neuraxial anesthesia. While effective for cesarean sections and labor analgesia, its use in orthopedic surgery for elderly patients remains unexplored. This study evaluates the efficacy and safety of DPE in elderly patients undergoing orthopedic surgery. Methods: A total of 126 elderly patients were randomly assigned to three groups: epidural block (EPL), combined spinal epidural block (CSE), and DPE. The primary outcome was the onset time of anesthesia. Secondary outcomes included maximum anesthesia level, Onset time of motor block, blood pressure, and heart rate at key points, anesthetic efficacy, and adverse reactions such as hypotension, respiratory depression, nausea and vomiting, chills, and bradycardia. Results: The onset time of anesthesia in the DPE group was significantly shorter than in the EPL group (17.6±4.0 min vs 19.2±3.9 min, P=0.037) but longer than in the CSE group (17.6±4.0 min vs 7.0±2.8 min, P