Current neuraxial techniques for labour analgesia in the UK: a survey of OAA members

Abstract

Introduction: Neuraxial labour analgesia can be delivered via labour epidural analgesia (LEA), combined spinal-epidural (CSE), or dural puncture epidural (DPE) techniques.1 While CSE may offer faster onset and improved block quality compared with LEA, DPE has been proposed as an alternative combining some advantages of CSE while avoiding full intrathecal dosing.2 Despite emerging evidence, real-world adoption of DPE in the UK remains unclear. This study aimed to characterise current UK practice, including first line neuraxial analgesia, CSE technical preferences, and DPE awareness and uptake. Method(s): A cross-sectional survey was distributed electronically to 1,906 UK-based members of the Obstetric Anaesthetists' Association (OAA) between June and July 2025. The nine-item survey collected demographics, routine neuraxial practice, technical aspects of CSE, and DPE familiarity and use, with three questions allowing free-text responses. Responses were anonymised, analysed descriptively and thematic analysis performed on free-text data. Result(s): A total of 338 clinicians responded (18% response rate), predominantly consultants (76%). Most respondents routinely provide LEA (93.2%), with CSE used less frequently (6.5%) and DPE rarely used (0.3%). Among those performing CSE, needle-through-needle (NTN) technique was slightly more common than separate-needle technique (56.6% vs 43.4%). Spinal needle gauge selection varied, with 25G and 27G most commonly used, and intrathecal regimens typically comprised low-dose local anaesthetic-opioid mixtures (0.1% bupivacaine/levobupivacaine with 2 microg/mL fentanyl). Awareness of DPE was high (93.7%), yet 65% would not consider its use. Thematic analysis highlighted recurring considerations: safety concerns, preference for existing techniques, limited robust evidence. Among the few using DPE (4%), application was situational, including advanced labour, high BMI, or unilateral block. Discussion(s): LEA remains the dominant method of labour analgesia in the UK, with CSE adopted selectively and DPE rarely implemented despite high awareness. Barriers to DPE uptake include perceived risks, limited demonstrated advantage over CSE, and lack of high-quality evidence and consensus guidelines. These findings provide a contemporary snapshot of UK practice, highlight areas of variability in neuraxial labour analgesia, and underscore the prevailing caution and limited adoption of DPE among clinicians. [Formula presented] Copyright © 2026