Addition of clonidine to a continuous patient‐controlled epidural infusion of low‐concentration levobupivacaine plus sufentanil in primiparous women during labour

Bazin, M.; Bonnin, M.; Storme, B.; Vernis, L.; Lavergne, Bernard; Pereira, Bruno; Bazin, J. E.; Dualé, Christian

doi:10.1111/j.1365-2044.2011.06785.x

Cited by 19 publications

(18 citation statements)

References 25 publications

(45 reference statements)

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“…The combined use of ropivacaine, 0.25 µg/ml Dex and 0.25 µg/ml sufentanil displayed a quicker onset time, enhanced the analgesic effect, decreased the VAS scores, reduced the bolus frequency and limited motor blockage without causing adverse side effects compared with the use of either adjuvants alone. The results indicated that Dex synergized with sufentanil systemically and regionally, which was consistent with previously reported clinical results (26,30).…”

Section: Discussionsupporting

confidence: 92%

Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: A randomized controlled trial

Xiao

et al. 2020

Exp Ther Med

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Opioids and α2-agonists have been used as epidural adjuvants in local anesthetics for a long time, but the effect of the combination of opioids and α2-agonists as epidural adjuvants is not completely understood. In the present study, the combination of dexmedetomidine (Dex) and sufentanil as adjuvants to ropivacaine for epidural labor analgesia was investigated. A total of 108 parturient women receiving labor epidural analgesia were randomly divided into three groups: i) Group RD received 0.1% ropivacaine + 0.5 µg/ml Dex; ii) Group RS received 0.1% ropivacaine + 0.5 µg/ml sufentanil; and iv) Group RDS received 0.1% ropivacaine + 0.25 µg/ml Dex + 0.25 µg/ml sufentanil. Patients received a 10 ml loading dose followed by a maintenance by patient controlled epidural analgesia. The visual analog scale scores, onset time, local anesthetic requirements, motor blockage and adverse effects were recorded. Group RDS displayed an improved labor analgesia effect compared with Groups RD and RS. Group RDS displayed a shorter onset time compared with Groups RD and RS, and a reduced local anesthetic requirement compared with Group RS. The motor blockage in Groups RDS and RS was significantly lower compared with Group RD, and the incidence of pruritus in Groups RDS and RD was lower compared with Group RS. In conclusion, the combined use of 0.25 µg/ml Dex and 0.25 µg/ml sufentanil as adjuvants to 0.1% ropivacaine for epidural labor analgesia displayed an improved analgesia effect compared with the use of either 0.5 µg/ml sufentanil or 0.5 µg/ml Dex alone. The present study was registered with the Chinese Clinical Trial Registry Center on 23 February, 2018 (registration no. ChiCTR-IOR-1800014943).

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Section: Discussionsupporting

confidence: 92%

Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: A randomized controlled trial

Xiao

et al. 2020

Exp Ther Med

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“…In agreement with previous studies, 18 , 27 , 39 , 40 a significant reduction in the perioperative heart rate was observed in group bupivacaine + dexmedetomidine, and we detected three cases where patients developed bradycardia and they were successfully managed with atropine. Likewise, a significant reduction in systolic and diastolic blood pressure occurred in group bupivacaine + dexmedetomidine perioperatively.…”

Section: Discussionsupporting

confidence: 93%

Epidural dexmedetomidine infusion for perioperative analgesia in patients undergoing abdominal cancer surgery: randomized trial

Hetta

Fares

Abedalmohsen³

et al. 2018

JPR

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ObjectiveTo assess the postoperative analgesic efficacy of epidural dexmedetomidine added to bupivacaine infusion for patients undergoing major abdominal cancer surgery.MethodsPatients scheduled for major upper abdominal cancer surgery were allocated to group bupivacaine (n =32), in which patients received epidural bupivacaine infusion (6 mL/h bupivacaine 0.1%) for 48 hours postoperatively, or group bupivacaine + dexmedetomidine (n=32), in which patients received epidural dexmedetomidine added to bupivacaine infusion (6 mL/h of bupivacaine 0.1% + dexmedetomidine, 0.5 µg/mL) for 48 hours postoperatively. The cumulative morphine consumption, the time to first analgesic request, and the VAS pain score were evaluated.ResultsThe cumulative morphine consumption was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine: mean ± SD of 10.40±5.16 mg vs 23.23±8.37 mg with an estimated difference (95% CI) of −12.83 (−16.43, −9.24), (P<0.001). The time to the first analgesic demand was significantly delayed in group bupivacaine + dexmedetomidine compared with group bupivacaine: median (IQR) of 6 (1.75, 8.25) h vs 1 (0, 4)h, (P<0.001). The mean collapsed over time of overall VAS pain scores at rest and movement was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine : mean ± SE of 1.6±0.08 vs 2.38±0.08 with an estimated difference (95% CI) of −0.8 (−1, −0.86), (P<0.001), and mean ± SE of 2.17±0.07 vs 3.25±0.07 with an estimated difference (95% CI) of −1.1 (−1.27, – 0.89), (P<0.001), respectively.ConclusionEpidural infusion of dexmedetomidine added to bupivacaine for patients undergoing major abdominal cancer surgery significantly reduced morphine consumption, delayed time to first analgesic supplementation, and decreased pain intensity during the first 48 hours postoperatively without harmful derangement on hemodynamics.

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“…Three studies 19,21,26 involving 279 parturients were included for this comparison, with the concentrations of clonidine of 1.36 μg/ml, 19 4.5 μg/ml, 21 and 2 μg/ml 26 . The opioids used were sufentanil 19,26 and fentanyl, 21 respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies reported motor block. Of them, two 21,26 reported the incidences of parturients developing motor block as defined by inability to keep legs raised, and pooled data showed no difference between two groups (Figure 3); another study 19 reported that the number of motor block related to the total number of observations in labor was not significantly different between two groups (10/371 [2.7%] vs. 5/385 [1.3%], P = 0.198). Nausea and pruritus were reported in two studies, 21,26 but the different ways they were reported precluded a meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of epidural clonidine by continuous infusion or patient‐controlled analgesia in labor: A meta‐analysis of randomized controlled trials

Feng

Wang

Chang

et al. 2022

Intl J Gynecology & Obste

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Background Epidural clonidine improves analgesia but may induce adverse effects in labor. Objective To evaluate the efficacy and safety of epidural clonidine as local anesthetics (LA) adjuvant by continuous infusion or patient‐controlled epidural analgesia (PCEA) in labor. Search Strategy PubMed, Embase, Web of Science, and CENTRAL were searched from inception to May 10, 2022 without language restriction; references of the retrieved studies were hand searched. Selection Criteria Randomized controlled trials (RCTs) comparing epidural LA with and without clonidine using continuous infusion or PCEA in labor were included. Data Collection and Analysis A random effects model was used to pool the data on analgesia and adverse effects. Main Results Eight RCTs were included. Clonidine did not reduce the incidence of parturients requiring additional epidural boluses but reduced LA consumption and pain scores without increasing adverse effects, except for a higher incidence of instrumental delivery when clonidine was combined with LA and opioid (risk ratio 2.38, 95% confidence interval 1.26–4.50). Clonidine offered similar analgesia to opioids but had reduced opioid‐related adverse effects. Trial sequential analysis showed that the evidence was insufficient. Conclusions Epidural clonidine by continuous infusion or PCEA does not increase significant adverse effects and offers similar analgesia to opioids in labor. PROSPERO registration no. CRD42022306565.

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Addition of clonidine to a continuous patient‐controlled epidural infusion of low‐concentration levobupivacaine plus sufentanil in primiparous women during labour

Cited by 19 publications

References 25 publications

Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: A randomized controlled trial

Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: A randomized controlled trial

Epidural dexmedetomidine infusion for perioperative analgesia in patients undergoing abdominal cancer surgery: randomized trial

Efficacy and safety of epidural clonidine by continuous infusion or patient‐controlled analgesia in labor: A meta‐analysis of randomized controlled trials

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