In some ways this is like the surgeon who complains about a 10 minute delay and then goes on to take 4.5hrs to do a hernia...
Labor and contractions have been happening for hours (sometimes days).
There are so many other factors that are at play to determine the time that the contraction pain stops and mom gets comfy.... at what point do they go to the hospital, how long does check in take, now we start the iv and give a bolus, hold on the nurses are changing shift, hold on i have to go to the bathroom, etc...
so why am i going to go above and beyond ( and more importantly arguably add a level of risk ) for a possible 2-5 minute difference (which is like 1-2 contractions)? im not even going to dose through the needle... i do it the way i always do it and dont let the hysterics of the others throw me off and lead me to a complication...needle gets placed, catheter goes in, test dose, bolus 2% lido with epi.
The only time that I have done DPE was as a resident, and while i agree that it doesnt make sense to puncture the dura and then not give anything, i was taught that the purpose of the puncture is to confirm proper epidural positioning if a possible false loss of resistance should occur during a difficult placement. meaning that if you can puncture the dura through the tuohy then you are in the right place with your tuohy , which again is an assumption