Epidural clonidine added to a bupivacaine infusion increases analgesic duration in labor without adverse maternal or fetal effects

Parker, Robert K.; Connelly, Neil Roy; Lucas, Tanya; Serban, Stelian; Pristas, Rene; Berman, Evan M.; Gibson, Charles Stanley

doi:10.1007/s00540-006-0476-8

Cited by 33 publications

(44 citation statements)

References 28 publications

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“…Clonidine being a α-2 agonist, is known to increase the effectiveness of local anaesthetic agent in epidural labour analgesia in many studies [11,[14][15][16]. The dose of clonidine used in our study was 1mcg/kg in loading bolus, which approximates to 50-70 mcg clonidine in loading bolus.…”

Section: Discussionmentioning

confidence: 99%

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Ahirwar

Prakash

Kushwaha

et al. 2014

JCDR

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Background: Feeling of pain is one of the most important emotional determinants which dominate the perception of females who undergo the process of labour and delivery. Patient controlled epidural labour analgesia (PCEA) is convenient and safer technique for this purpose. Very few studies compared clonidine and fentanyl with ropivacaine in labour analgesia in past. This study was undertaken to compare fentanyl and clonidine in PCEA. Aims:To compare low concentration ropivacaine with or without fentanyl or clonidine for labour analgesia and its effect on maternal and foetal safety. Settings and Design:Prospective, double blind, randomized, comparative study. Materials and Methods:Ninety primegravida in labour were divided into three groups (n=30) and patient controlled epidural labour analgesia was given to them: Initial bolus of 10ml of ropivacaine 0.125% in Group I; with fentanyl 2 µg/ml in Group II and with clonidine 1µg/kg in Group III. Subsequently each group received ropivacaine 0.125% through patient controlled epidural analgesia (PCEA) as background infusion of 5 ml/hr with lockout interval time of 10min and subsequent bolus of 5ml. Hemodynamic parameters, sensory level, motor block and pain relief were noted. Total analgesic dose of local anaesthetic and feto-maternal adverse effects were also recorded.Results: At baseline, groups were matched demographically, hemodynamically as well as for intensity of pain. There was a statistically significant decrease in hemodynamic parameters from baseline in all groups with maximum reduction in group III. A significant difference among groups in VAS was observed at zero min and from 120min till 240min intervals and lowest values were in Group III. No significant difference was observed among the groups for mode of delivery and expulsive efforts. Total analgesic dose and PCA bolus requirement was maximum in Group I and minimum in Group III and the difference was statistically significant among groups. Six (20%) patients had shivering in Group II and hypotension was recorded in only 1 (3.3%) patient of Group III.Conclusion: Ropivacaine 0.125% was effective in decreasing labour pain without any motor blockade. Clonidine 1µg/kg was superior to fentanyl 2µg/ml as an

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Section: Discussionmentioning

confidence: 99%

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Ahirwar

Prakash

Kushwaha

et al. 2014

JCDR

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“…Similarly, addition of clonidine (5 mg/mL) to bupivacaine infusion in primigravid women, followed by fentanyl administration, significantly prolongs the time of analgesia without increasing secondary effects. 96 Combination of epidural clonidine, local anesthetics and opioids have remarkably improved…”

Section: Clonidinementioning

confidence: 99%

α₂‐Agonists as analgesic agents

Giovannoni¹,

Ghelardini²,

Vergelli³

et al. 2008

Medicinal Research Reviews

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It is well known that norepinephrine is involved in the control of pain by modulating pain-related responses through various pathways. alpha(2)-Adrenergic agonists have a well-established analgesic profile and, in the recent years, have found a wider application, in particular as adjunct to anesthetics and analgesics in perioperative settings. This review analyzes the alpha(2)-agonists currently in clinical use, starting from the prototype Clonidine, as well as the most promising and studied molecules. In addition, an overview of the imidazoles, imidazolines, and hydroxyethyl-thioureas derivatives published in both the open and patented literature is presented, providing chemical description and pharmacological data. Finally, the most commonly alpha(2)-agonists used in veterinary medicine are described.

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“…Adjunctive treatments under appropriate inpatient supervision may include use of clonidine (0.1-0.2 mg every 8 hours), which has been shown to be safe in pregnancy as an adjunct to epidural analgesia. 43 Referral to detoxification services should be accompanied by close, ongoing, coordinated follow-up by the primary care physician, obstetrician, or addictions specialist. Concurrent participation in Alcoholics Anonymous meetings, specialized support groups for pregnant women attempting medically monitored sobriety, and individualized social work services are recommended for the pregnant woman undergoing alcohol treatment to ensure that the female patient will have the supports required to maintain sobriety as well as to care for a child who may prove to have special needs in the immediate postpartum period and its aftermath.…”

Section: Should Pregnant Alcohol Users Be Reported To the Authorities?mentioning

confidence: 99%

Alcohol Use During Pregnancy: Prevalence and Impact

Bhuvaneswar¹,

Chang²,

Epstein³

et al. 2007

Prim. Care Companion J. Clin. Psychiatry

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Epidural clonidine added to a bupivacaine infusion increases analgesic duration in labor without adverse maternal or fetal effects

Abstract: In early laboring patients, addition of clonidine prolongs the analgesia duration of a 0.625 mg.ml(-1) bupivacaine continuous epidural infusion following 100 microg epidural fentanyl (after a lidocaine-epinephrine test dose) without a clinically significant increase in side effects.

Cited by 33 publications

References 28 publications

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

α₂‐Agonists as analgesic agents

Alcohol Use During Pregnancy: Prevalence and Impact

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Epidural clonidine added to a bupivacaine infusion increases analgesic duration in labor without adverse maternal or fetal effects

Abstract: In early laboring patients, addition of clonidine prolongs the analgesia duration of a 0.625 mg.ml(-1) bupivacaine continuous epidural infusion following 100 microg epidural fentanyl (after a lidocaine-epinephrine test dose) without a clinically significant increase in side effects.

Cited by 33 publications

References 28 publications

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

α2‐Agonists as analgesic agents

Alcohol Use During Pregnancy: Prevalence and Impact

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α₂‐Agonists as analgesic agents