Intrathecal Clonidine Combined with Sufentanil for Labor Analgesia

Background Intrathecal sufentanil provides rapid-onset and complete analgesia for the first stage of labor. The dose required to produce this effect can be associated with maternal respiratory depression, hypotension, nausea, or pruritus. Because clonidine potentiates the analgesic effects of opioids without increasing their side effects, the authors wanted to determine the efficacy of low doses of intrathecal clonidine (15 and 30 microg) combined with sufentanil. Methods Ninety-eight parturient requesting labor analgesia were studied. In a combined spinal-epidural technique, patients were randomly assigned to receive one of the following intrathecal solutions: either 15 microg clonidine (n = 10); 30 microg clonidine (n = 10); 2.5 microg sufentanil (n = 13); 5 microg sufentanil (n = 13); 2.5 microg sufentanil and 15 microg clonidine (n = 13); 2.5 microg sufentanil and 30 microg clonidine (n = 13); 5 microg sufentanil and 15 microg clonidine (n = 13); or 5 microg sufentanil and 30 microg clonidine (n = 13). Visual analog scores for pain, blood pressure, heart rate, sensory levels, incidence of nausea and pruritus, and motor blockade, and maternal and cord blood concentrations of clonidine were recorded. Results Patients receiving 30 microg intrathecal clonidine with 2.5 or 5 microg intrathecal sufentanil had significantly longer-lasting analgesia (145 +/- 36 and 145 +/- 43 min vs. 104 +/- 35 for those receiving 5 microg intrathecal sufentanil alone). Clonidine levels were undetectable in maternal serum. Conclusions Thirty micrograms of intrathecal clonidine combined with 2.5 or 5 microg intrathecal sufentanil significantly increased the duration of analgesia during the first stage of labor without adverse maternal or fetal effects.

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COMBINED SPINAL EPIDURAL ANALGESIA IN LABOUR

Fetal and Maternal Medicine Review ◽

10.1017/s0965539504001421 ◽

2005 ◽

Vol 16 (1) ◽

pp. 29-50 ◽

Cited By ~ 1

Author(s):

MARGO LEWIS ◽

NICOLA CALTHORPE

Keyword(s):

Epidural Catheter ◽

Pain Control ◽

Rapid Onset ◽

Motor Blockade ◽

Operative Delivery ◽

Single Procedure ◽

Combined Spinal Epidural ◽

Post Operative Pain ◽

Spinal Epidural ◽

Speed Of Onset

The combined spinal epidural (CSE) as an anaesthetic technique for providing analgesia for labour and anaesthesia for operative delivery has gained in popularity over the last ten years. Essentially the CSE consists of identification of the epidural space and insertion of an epidural catheter plus the initial intentional placement of an intrathecal dose of opioid, local anaesthetic or both, all as a single procedure. Theoretically the technique combines the advantages of the speed of onset and the reliability of block achieved by subarachnoid anaesthesia with the flexibility provided by the presence of an epidural catheter and avoids their individual disadvantages. The complications that may be encountered are those attributable to subarachnoid and epidural anaesthesia individually but some are unique to the CSE technique. The CSE technique is also applicable to other situations in obstetrics where a block is initiated by subarachnoid anaesthesia and its continuation is facilitated by the presence of an epidural catheter, either to maintain anaesthesia for prolonged procedures or for post operative pain control. The CSE's popularity has been ensured by the fact that it has allowed rapid onset analgesia with minimal motor blockade to be provided routinely for mothers in labour.

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Analgesic and Hemodynamic Effects of Intrathecal Clonidine as the Sole Analgesic Agent during First Stage of Labor

Anesthesiology ◽

10.1097/00000542-199908000-00012 ◽

1999 ◽

Vol 91 (2) ◽

pp. 388-396 ◽

Cited By ~ 50

Author(s):

Astrid Chiari ◽

Christine Lorber ◽

James C. Eisenach ◽

Eckart Wildling ◽

Claus Krenn ◽

...

Keyword(s):

Heart Rate ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Maternal Blood ◽

Labor Analgesia ◽

Double Blind Study ◽

Double Blind ◽

Intrathecal Clonidine ◽

Dose Dependent ◽

First Stage Of Labor

Background Intrathecal clonidine produces dose-dependent postoperative analgesia and enhances labor analgesia from intrathecal sufentanil. The authors evaluated the dose-response potency of intrathecally administered clonidine by itself during first stage of labor with respect to analgesia and maternal and fetal side effects. Methods Thirty-six parturients requesting labor analgesia were included in this prospective, randomized, double-blind study. Parturients with < 6 cm cervical dilatation received either 50, 100, or 200 microg intrathecal clonidine. The authors recorded visual analog pain score (VAPS), maternal blood pressure and heart rate, ephedrine requirements, and sedation at regular intervals and fetal heart rate tracings continuously. Duration of analgesia was defined as time from intrathecal clonidine administration until request for additional analgesia. Results Clonidine produced a reduction in VAPS with all three doses. The duration of analgesia was significantly longer in patients receiving 200 microg (median, 143; range, 75-210 min) and 100 microg (median, 118; range, 60-180 min) than 50 microg (median, 45; range, 25-150 min), and VAPS was lower in the 200-microg than in the 50-microg group. In the 200-microg group, hypotension required significantly more often treatment with ephedrine than in the other groups. No adverse events or fetal heart rate abnormalities occurred. Conclusions Fifty to 200 microg intrathecal clonidine produces dose-dependent analgesia during first stage of labor. Although duration and quality of analgesia were more pronounced with 100 and 200 microg than with 50 microg, the high incidence of hypotension requires caution with the use of 200 microg for labor analgesia.

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Minimum Local Analgesic Doses of Ropivacaine, Levobupivacaine, and Bupivacaine for Intrathecal Labor Analgesia

Anesthesiology ◽

10.1097/00000542-200503000-00025 ◽

2005 ◽

Vol 102 (3) ◽

pp. 646-650 ◽

Cited By ~ 71

Author(s):

Michela Camorcia ◽

Giorgio Capogna ◽

Malachy O. Columb

Keyword(s):

Local Anesthetic ◽

Labor Analgesia ◽

Allocation Model ◽

Analgesic Dose ◽

Sequential Allocation ◽

Visual Analog Pain Score ◽

Spinal Epidural ◽

To Receive ◽

Local Anesthetic Drug ◽

Analgesic Potency

Background Doses for intrathecal opioid-local anesthetic mixtures have been arbitrarily chosen. The aim of this study was to compare the analgesic efficacies of intrathecal ropivacaine, levobupivacaine, and bupivacaine for labor analgesia and to determine the analgesic potency ratios for these three drugs. For this purpose, the authors used the up-down sequential allocation model, which estimates the minimum local analgesic dose for intrathecal local anesthetic. Methods Ninety-seven nulliparous term parturients in spontaneous labor, requesting combined spinal-epidural analgesia, were randomly allocated to one of three groups to receive 0.25% spinal ropivacaine, levobupivacaine, or bupivacaine. The initial dose of the local anesthetic drug was chosen to be 2.5 mg, and the testing interval was set at 0.25 mg. The subsequent doses were determined by the response of the previous parturient. Efficacy was accepted if the visual analog pain score decreased to 10 mm or less on a 100-mm scale within 30 min. The minimum local analgesic dose was calculated using the method of Dixon and Massey. Results The intrathecal minimum local analgesic dose was 3.64 mg (95% confidence interval, 3.33-3.96 mg) for ropivacaine, 2.94 (2.73-3.16) mg for levobupivacaine, and 2.37 (2.17-2.58) mg for bupivacaine. The relative analgesic potency ratios were 0.65 (0.56-0.76) for ropivacaine:bupivacaine, 0.80 (0.70-0.92) for ropivacaine:levobupivacaine, and 0.81 (0.69-0.94) for levobupivacaine:bupivacaine. There were significant trends (P </= 0.021) for greater motor block with bupivacaine and levobupivacaine. Conclusions This study suggests a potency hierarchy of spinal bupivacaine > levobupivacaine > ropivacaine.

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Intrathecal Clonidine and Neostigmine Prolong the Duration of Bupivacaine-Fentanyl with Combined Spinal-Epidural Labor Analgesia

Anesthesiology ◽

10.1097/00000542-199809180-00051 ◽

1998 ◽

Vol 89 (Supplement) ◽

pp. 1068A

Author(s):

Ozer Ozsarac ◽

Medge Owen ◽

Sukran Sahin ◽

Nesimi Uckunkaya ◽

Nuray Kaplan ◽

...

Keyword(s):

Labor Analgesia ◽

Combined Spinal Epidural ◽

Intrathecal Clonidine ◽

Spinal Epidural

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Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study

International Journal of Advanced and Integrated Medical Sciences ◽

10.5005/jp-journals-10050-10080 ◽

2017 ◽

Vol 2 (2) ◽

pp. 73-77

Author(s):

Malti Agrawal ◽

Yogesh K Sharma

Keyword(s):

Side Effects ◽

Comparative Study ◽

Randomized Study ◽

Rapid Onset ◽

Labor Analgesia ◽

Singleton Pregnancy ◽

Double Blind ◽

Sensory Blockade ◽

Combined Spinal Epidural ◽

Spinal Epidural

ABSTRACT Introduction Combined spinal–epidural analgesia to provide pain relief in labor has become the technique of choice. It provides benefits of both spinal analgesia and flexibility of an epidural catheter. In this study, we compared levobupivacaine with fetanyl and ropivacaine with fentanyl in terms of onset and duration of sensory blockade. Materials and methods This was a double-blind randomized study on 60 parturients of American Society of Anesthesiologists status 1 and 2, all primipara with singleton pregnancy in active labor, were allocated randomly into two groups of 30 each. Group L received 3 mg of levobupivacaine intrathecally with 25 µg fentanyl followed by epidural top-ups of 14 mL levobupivacaine 0.125% with fentanyl 30 µg, whereas group R received 4 mg of ropivacaine intrathecally with 25 µg of fentanyl followed by epidural top-ups of 14 mL ropivacaine 0.2% with fentanyl 30 µg. Sensory and motor characteristics, hemodynamics, maternal and fetal outcomes, side effects, and complications were observed and analyzed statistically using Student's unpaired t-test and chi-squared test. Results A rapid onset of analgesia in group L (4.67 ± 0.35) as compared with group R (5.57 ± 0.27) was observed. Duration of analgesia was also prolonged in group B (116.83 ± 6.91) as compared with group R (88.87 ± 5.10). Patients remained hemodynamically stable, and side effects and complications were comparable in both groups. Conclusion Levobupivacaine with fentanyl combination was found to be more promising in terms of onset and duration of labor analgesia as compared with ropivacaine and fentanyl combination. How to cite this article Sharma YK, Agrawal M. Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study. Int J Adv Integ Med Sci 2017;2(2):73-77.

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Low-dose Clonidine and Neostigmine Prolong the Duration of Intrathecal Bupivacaine–Fentanyl for Labor Analgesia

Anesthesiology ◽

10.1097/00000542-200002000-00016 ◽

2000 ◽

Vol 92 (2) ◽

pp. 361-361 ◽

Cited By ~ 64

Author(s):

Medge D. Owen ◽

Özer Özsaraç ◽

Şükran Şahin ◽

Nesimi Uçkunkaya ◽

Nuray Kaplan ◽

...

Keyword(s):

Side Effects ◽

Low Dose ◽

Fetal Heart ◽

Vital Signs ◽

Labor Analgesia ◽

Pain Scores ◽

Active Labor ◽

Effective Pain Relief ◽

Spinal Epidural ◽

To Receive

Background Intrathecal (IT) opioid and local anesthetic combinations are popular for labor analgesia because of rapid, effective pain relief, but the duration of analgesia is limited. This study was undertaken to determine whether the addition of clonidine and neostigmine to IT bupivacaine-fentanyl would increase the duration of analgesia without increasing side effects for patients in labor. Methods Forty-five healthy parturients in active labor were randomized to receive a 2-ml IT dose of one of the following dextrose-containing solutions using the combined spinal-epidural technique: (1) bupivacaine 2.5 mg and fentanyl 25 microg (BF); (2) BF plus clonidine 30 microg (BFC); or (3) BFC plus neostigmine 10 microg (BFCN). Pain, sensory levels, motor block, side effects, maternal vital signs, and fetal heart rate were systematically assessed. Results Patients administered BFCN had significantly longer analgesia (165+/-32 min) than those who received BF (90+/-21 min; P<0.001) or BFC (123+/-21 min; P<0.001). Pain scores, block characteristics, maternal vital signs, Apgar scores, maternal satisfaction, and side effects were similar among groups except for nausea, which was significantly greater in the BFCN group (P<0.05 as compared with BFC). Conclusions The addition of clonidine and neostigmine significantly increased the duration of analgesia from IT bupivacaine-fentanyl during labor, but neostigmine caused more nausea. Although serious side effects were not observed in this study, safety must be further addressed before the routine use of multiple IT drugs is advocated.

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