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Abstract The dural puncture epidural technique is a modification of the combined spinal epidural technique, where a dural perforation is created from a spinal needle but intrathecal medication administration is withheld, followed by placement of a catheter into the epidural space. (3) The dural puncture creates a conduit for translocation of medications from the epidural to subarachnoid spaces, a process that is believed to be responsible for the unique characteristics that are observed with the DPE technique. DPE has been shown to improve sacral block onset and spread of anesthesia, allows verification of epidural space proximity, improved hemodynamic stability, assessment of epidural catheter function, and reduced unblocked segments compared with epidural |