SummaryWe studied the potentiation of analgesia for labour by the addition of clonidine to epidural low-concentration levobupivacaine with sufentanil in a randomised, double-blinded study. We enrolled primiparous women who were in spontaneous labour. The study solutions, made of 100 ml levobupivacaine 0.0625% plus sufentanil 0.45 lg.ml )1 and either 150 lg clonidine or no clonidine, were used for induction of analgesia, and for its maintenance with self-administered boluses and a continuous background infusion. The need for additional epidural boluses during labour was lower and analgesia and maternal satisfaction were better in the clonidine (n = 57) than in the control group (n = 58). Blood pressure was lower and the rate of instrumental delivery higher in the clonidine group. Clonidine (1.36 lg.ml) added to the epidural solution of lowconcentration levobupivacaine improves the quality of analgesia. The relevance of the haemodynamic effects should be explored in larger validation studies. To relieve pain during labour with the fewest side effects possible, different solutions have been proposed. These include lowering the concentration of local anaesthetics and ⁄ or adding opioids to the anaesthetic solution, and developing less toxic drugs than bupivacaine [1]. We recently studied the effects of two formulations of levobupivacaine (0.0625% and 0.125%) for analgesia during labour in primiparous women, both with sufentanil 0.45 lg.ml )1 [2]. The solution was patient-administered after a first injection of 15-20 ml for induction. With low-concentration levobupivacaine, analgesia was sometimes insufficient, while high-concentration levobupivacaine provided better analgesia, but doses sometimes exceeded recommended limits. We hypothesised that addition of low-dose clonidine to low-concentration levobupivacaine would improve the quality of analgesia without exceeding recommended dose limits. Clonidine is known to potentiate epidural analgesia through inhibition of nociceptive transmission in the spinal cord via a2 receptors and through local anaesthetic effects [3,4]. Although epidural clonidine for labour is usually administered as a single injection [5,6], the addition of clonidine in epidural infusions has also been shown to improve analgesia during labour [7][8][9][10][11]. However, as concentrations over 2 lg.ml )1 may lead to more side effects [8,[10][11][12], we chose a safer dose of 150 lg of clonidine, diluted in our prefilled bags,
SummaryThe effects of two different concentrations of epidural levobupivacaine were compared when used to provide analgesia for labour. Primiparous women in spontaneous uncomplicated labour were enrolled in a prospective, randomised and partially double-blinded study. The study solutions were either 0.568 mg.ml )1 levobupivacaine (low concentration group) or 1.136 mg.ml )1 levobupivacaine (high concentration group), with sufentanil 0.45 lg.ml )1 added to both solutions. Epidural analgesia was initiated with 20 ml of the study solution, followed by a standardised algorithm of top-up bolus injections. Epidural analgesia was then continued by self-administered boluses of 5-ml plus a continuous infusion of 5 ml.h)1
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