Patient-controlled epidural analgesia in labor: The addition of clonidine to bupivacaine-fentanyl

Paech, Michael J.; Pavy, T. J. G.; Orlikowski, Christopher E. P.; Evans, Sharon F.

doi:10.1016/s1098-7339(00)80008-5

Cited by 37 publications

(42 citation statements)

References 24 publications

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“…[7] Evidence to conclude, improved quality of analgesia in the post-operative period. [8] Also there is not of much difference in the onset of analgesia, similar to the other studies. [9] The time to two segment regression also was longer with C>B>A, similar to the studies.…”

Section: Discussionsupporting

confidence: 86%

Comparative Evaluation of The Effects of Addition of Intrathecal Fentanyl and Clonidine Added to 0.5% Hyperbaric Bupivacaine for Lower Segment Caesarean Section

Selvarajan¹,

Ahila²,

Anandan³

2017

Ann. Int. Med. Den. Res.

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Background: Additive effects of intrathecal fentanyl and clonidine added to 0.5% hyperbaric bupivacaine for lower segment caesarean section is a simple, safe technique for patients undergoing elective (or) emergency LSCS under ASA I and II category, thus providing improved intra operative analgesia, prolonged post operative analgesia and stable Hemodynamics. Aim: To evaluate the effects of fentanyl and clonidine added to Bupivacaine, for caesarean section in spinal Anaesthesia. Methods: The three groups were namely A (Bupivacaine only), B (Bupivacaine + intrathecal clonidine) and C (Bupivacaine + intrathecal fentanyl + Clonidine). Each group 40 Caesarean Sections were selected and data were collected before during and after surgery. Results: The sensory level T4 was obtained by Group C was significantly greater than the other A & B groups (P<0.0001). The two-segment regression time for Group C was significantly more than Group B. The sedation level of A (57.5%) and B (70%) groups was associated with level 1 and C (72.5%) was associated with level 2. The improvement was very highly significant (P<0.001). The Apgar score between the three groups was not significant at 1 Minute, But at 5 minutes, Group A was significantly improved than Group B (9.1±0.5 > 8.8 ±0.5 and P<0.05). Conclusion: Clonidine when added to a bupivacaine-fentanyl mixture increased the duration of effective analgesia and the duration of sensory and motor block in lower segment caesarean section.

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Section: Discussionsupporting

confidence: 86%

Comparative Evaluation of The Effects of Addition of Intrathecal Fentanyl and Clonidine Added to 0.5% Hyperbaric Bupivacaine for Lower Segment Caesarean Section

Selvarajan¹,

Ahila²,

Anandan³

2017

Ann. Int. Med. Den. Res.

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“…Hasil penelitian pemberian klonidin 4,5 µg secara bertahap pada epidural dengan bupivakain plus fentanil untuk patient controlled epidural analgesia (PCEA) yang dipergunakan untuk analgetik pada persalinan ternyata tidak bermakna dalam menurunkan kejadian menggigil, kebutuhan analgetik, serta efek samping. [8][9][10] Penelitian lain tentang pemberian klonidin melalui intratekal sebagai adjuvan analgetika pada persalinan dengan teknik anestesia spinal didapatkan bahwa penambahan klonidin 30 µg pada bupivakain 2,5 mg dan fentanil 20 µg menurunkan kejadian menggigil (6%) lebih baik daripada kelompok kontrol tanpa klonidin (31%), didapatkan pula hasil pada penelitian ini bahwa klonidin intratekal 15-30 µg tidak terdapat perbedaan efek samping di antara keduanya. Penelitian terbaru membandingkan spinal klonidin 15 µg sebagai adjuvan pada 10 mg bupivakain 0,5% plus morfin HCl 0,1 mg dengan 10 mg bupivakain 0,5% plus morfin HCl 0,1 μg serta NaCl 0,9% terhadap kejadian menggigil pada seksio sesarea dengan anestesi aspinal, terdapat perbedaan signifikan.…”

Section: Pendahuluanunclassified

Comparison of 15 µg and 30 µg Intrathecal Clonidine in 12.5 mg 0.5% Bupivacain for Post Spinal Anesthesia Shivering in Caesarean Section

Mansur¹,

Pradian²,

Bisri³

2015

jap

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AbstrakMenggigil pascaanestesi spinal merupakan efek samping yang sering terjadi. Penelitian ini bertujuan untuk membandingkan penambahan klonidin intratekal antara 15 µg dan 30 µg pada 12,5 mg bupivakain. Penelitian adalah eksperimental dengan uji klinis rancangan acak lengkap terkontrol buta tunggal pada 80 wanita yang menjalani seksio sesarea dengan anestesi spinal, status fisik American Society of Anesthesiologist (ASA) II, berusia 18-42 tahun, dibagi secara random menjadi dua kelompok, kelompok I menggunakan 12,5 mg bupivakain 0,5 % dan klonidin 15 µg, sedangkan kelompok II mendapat penambahan klonidin 30 µg. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung pada periode Oktober-Desember 2011. Perbandingan proporsi kejadian kedua kelompok dianalisis secara statistik menggunakan uji chi-kuadrat, sedangkan derajat menggigil dengan Uji Mann-Whitney. Hasil penelitian menunjukkan bahwa kejadian menggigil pascaanestesi pada kelompok II sebanyak 2 pasien, sedangkan pada kelompok I adalah 10 pasien. Simpulan, penambahan klonidin intaratekal 30 µg pada bupivacain 0,5% untuk mencegah menggigil pascaanestesi spinal lebih baik dibandingkan dengan klonidin intratekal 15 µg. Shivering is a frequently experienced side effect of post-subarachnoid block. This study aimed to determine the which of 15 µg dose and 30 µg dose of intrathecal Clonidine is better prevents Post anaesthesia shivering. The research was conducting by clinical trials of a single blind randomized controlled design. Eighty pregnant female patients with ASA physical status II, aged 18-42 years, who underwent a caesarean section were randomly divided into two groups, spinal anesthesia performed by using 12.5 0.5% mg bupivacain and 15 µg clonidine in Group I and the same dose of bupicavain but with 30 µg clonidine in group II. The incidence proportion of both groups were statistically compared using chi square test, while the degree of shivering was analyzed using Mann-Whitney test. The results showed that the characteristics of patient data and the core temperature did not statistically different between the two groups. The incidence and degree of shivering were different between the two groups, with were 2 patients experienced shivering incidence in group II and 10 patients experienced the incidence in group I. It is concluded that the addition of intrathecal 30 µg clonidine to 0.5% bupivacain prevents post-subarachnoid spinal block shivering better than in trathecal clonidine 15 µg.

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“…clonidine inhibits nociceptive transmission in spinal cord via  2 receptors, and may have in addition local anaesthetic effects (Singelyn et al, 1996;Kroin et al, 2004); 2. it was -at least in France -often used epidurally for labour as single injection, either at the induction of epidural analgesia or as a rescue treatment (Chassard et al, 1996;Landau et al, 2002); 3. the systematic addition of clonidine in the solution used for epidural infusion was known to improve post-operative analgesia in diverse models (Tremlett et al, 1999;Paech et al, 2000;Kayacan et al, 2004;Parker et al, 2007); 4. already two French studies used levobupivacaine 0.0625% given on PCEA with lowconcentrated clonidine, with promising results (Fontaine et al, 2008;Wallet et al, 2010); 5. we recently evidenced the stability over 24 hours of a solution in which levobupivacaine, sufentanil and clonidine were mixed together (Sautou et al, 2011).…”

Section: Improving Analgesic Efficacy Of Low Concentrated Solutionsmentioning

confidence: 99%

“…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).…”

Section: Outcome Effect Sizementioning

confidence: 99%

Local Anaesthetic Epidural Solution for Labour: About Concentrations and Additives

Dualé¹,

Bonnin²

2012

Epidural Analgesia - Current Views and Approaches

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Patient-controlled epidural analgesia in labor: The addition of clonidine to bupivacaine-fentanyl

Abstract: The addition of clonidine to epidural bupivacaine and fentanyl for PCEA in labor improved analgesia, reduced the supplementation rate, and reduced shivering. Increased sedation and lower BP were not clinically important.

Cited by 37 publications

References 24 publications

Comparative Evaluation of The Effects of Addition of Intrathecal Fentanyl and Clonidine Added to 0.5% Hyperbaric Bupivacaine for Lower Segment Caesarean Section

Comparative Evaluation of The Effects of Addition of Intrathecal Fentanyl and Clonidine Added to 0.5% Hyperbaric Bupivacaine for Lower Segment Caesarean Section

Comparison of 15 µg and 30 µg Intrathecal Clonidine in 12.5 mg 0.5% Bupivacain for Post Spinal Anesthesia Shivering in Caesarean Section

Local Anaesthetic Epidural Solution for Labour: About Concentrations and Additives

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