Comparison of 0.125% Bupivacaine With 0.125% Bupivacaine and Clonidine as Extradural Analgesia in the First Stage of Labour

Abstract

We have studied 42 healthy parturients with singleton vertex pregnancies, who were in the first stage of labour and requesting extradural analgesia. They were allocated randomly in a double-blind fashion to receive either 0.125% bupivacaine plain or 0.125% bupivacaine with clonidine 120 micrograms. Efficacy of analgesia was evaluated using linear visual analogue scoring (VAS), sensory block was assessed using bilateral pinprick in the mid-clavicular line and sedation scored on a five-point scale. Maternal and fetal cardiovascular variables were measured every 2 min for 20 min, at 30 min and subsequently at 15-min intervals. The reduction in VAS was greater at all times in the bupivacaine-clonidine group (P < 0.01). The median (range) duration of analgesia was greater in the bupivacaine-clonidine group (114.5 (30-243) min) compared with the bupivacaine group (53 (30-100) min) (P < 0.001). Analgesia was associated with a reduction in arterial pressure in both groups, but there were no between-group differences. Maternal heart rate was less than baseline values at 30-90 min in the bupivacaine-clonidine group only. Sedation was greater in the bupivacaine-clonidine group, especially from 15 to 45 min (P < 0.01). There were no differences in fetal heart rate, mode of delivery or Apgar scores between the two groups.

Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial

“…When comparing the labor analgesia obtained with bupivacaine added to 75 µg clonidine with that obtained for the control group, other authors have observed better analgesia in the clonidine group. 13,15 The need for additional local anesthetic among the patients in the present study demonstrated that clonidine allowed the duration of analgesia in the RC group to be equal to that of the R group. Cigarini et al 13 demonstrated that patients who received only bupivacaine required additional local anesthetic for labor analgesia within a shorter period of time than did women who received clonidine.…”

“…The ratio between the fetal and maternal plasma concentration is approximately 0.9, 13,19 since the drug is metabolized less by the fetus and is slowly eliminated by the fetus and neonate. 25 Some studies 13,15 have reported that newborns delivered by mothers who had received clonidine for labor analgesia did not differ from the control group in terms of Apgar score.…”

“…This result was the same as found in a clinical study comparing labor analgesia between patients receiving an equal volume of 0.125% bupivacaine alone or combined with 120 µg clonidine. 15 When only the local anesthetic was administered, the patients were able to move better. This may also have contributed towards longer duration of analgesia in the RC group.…”

Local Anaesthetic Epidural Solution for Labour: About Concentrations and Additives

“…Epidural clonidine is likely to induce dose-dependent side effects: & Gin, 1993;Paech et al, 2000;Aveline et al, 2002;Gurses et al, 2003;Roelants et al, 2005); -maternal hypotension (Chassard et al, 1996;Landau et al, 2002;Aveline et al, 2002;Gurses et al, 2003;Roelants et al, 2005;Parker et al, 2007;Wallet et al, 2010); -maternal bradycardia (O'Meara & Gin, 1993;Gurses et al, 2003;Huang et al, 2007); -abnormalities in foetal heart rhythm (Chassard et al, 1996;Tremlett et al, 1999).…”

Late Maternal Hypotension after Administration of a Mini-Dose of Clonidine Added to Epidural Analgesia for Labor

“…Epidural clonidine at a dose of 60µg, added to bupivacaine, increased the duration of analgesia in 30%, with no major adverse effects when compared to bupivacaine without additives [2]. Studies with larger epidural clonidine (120-150µg) doses showed significant adverse effects such as sedation, hypotension, bradycardia and fetal heart rate abnormalities [3][4][5][6]. In one study, lower doses (30 µg) showed no significant benefits [7].…”