Effects of 15 mcg intrathecal clonidine added to bupivacaine and sufentanil for labor analgesia

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Published Dec 12, 2011
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Vol. 89 No. 11 (2011): Issue Nov 2011

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Iheb Labbene
Hedi Gharsallah
Anis Abderrahman
Mondher Belhadj Amor
Walid Trabelsi
Zied Hajjej
Mustapha Ferjani

Abstract

Background: For the combined spinal epidural analgesia for labour, 30 mcg of subarachnoid clonidine has proved its effectiveness to extend the analgesia, but increased severe hemodynamic effects.
Aim: To assess the effectiveness and the safety of 15 mcg intra thecal clonidine for labour analgesia.
Methods: Four months, prospective, randomised, simple blind Study, including ASA I or II women, with mono foetal pregnancy. Patients were randomised in 2 groups: SB Group received intra thecal isobaric bupivacaine 2.5 mg and sufentanil 5 mcg and SBC Group received 15 mcg clonidine added to the same doses of
bupivacaïne and sufentanil. Epidural analgesia was used when VAS is more than 30. Studied parameters were: delay of installation, duration of analgesia, VAS score, hemodynamic parameters and the incidence of maternal and neonatal side effects.
Results: Sixty pregnant women were included (27 in SBC Group and 33 in SB group). The duration of initial analgesia was significantly longer in the SBC group (145 ± 43 min) compared with the SB group (98 ± 28 min). The delay of analgesia, sensory level and motor block level were similar. There was neither significant increase of the low incidence of blood pressure nor of the ephedrine consumption. The abnormalities of fetal heart rate, the mode of delivery and the incidence of side effects were also similar.
Conclusion: The addition of 15 mcg intra thecal clonidine to the bupivacaine and the sufentanil during combined spinal epidural analgesia for obstetrical labour results in extended significantly duration of analgesia without increasing side effects.

Keywords:

Clonidine, bupivacaine, sufentanil, obstetrical analgesia, spinal analgesia

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References

  1. Benhamou D. Adjuvants de l'anesthésie locorégionale en obstétrique. In:SFAR, ed. Conférences d'actualisation. Paris: Elsevier,1999: 43-52.
  2. Eisenach JC. Additives for epidural analgesia for labor: Why bother [editorial]. Reg Anesth Pain Med 1998; 23:531-2
  3. Belhadj Amor M, Draief A, Ouezini R et al. 30 ÃŒg de clonidine en intrathécal prolonge l'analgésie du travail, mais augmente l'incidence des hypotensions et des anomalies du rythme cardiaque foetal. Ann Fr Anesth Reanim 2007;26:916-20.
  4. Roger-Christoph S, Mercier FJ. Rachianalgésie au cours du travail. In : SFAR, ed. Conférences d'actualisation. Paris: Elsevier ,2001:65-76.
  5. Eisenach JC, De Kock M, Klimscha W. Alpha 2 adrenergic agonists for regional anesthesia. A clinical review of clonidine. Anesthesiology 1996; 85: 655-74.
  6. Yoshimura M, Furue H. Mechanisms for the anti nociceptive actions of the descending noradrenergic and serotoninergic systems of the spinal cord. J Pharmacol Sci 2006; 101:107-17.
  7. Gautier PE, De Kock M, Fanard L, Van Steenberge A, Hody JL. Intrathecal clonidine combined with sufentanil for labor analgesia. Anesthesiology 1998;89: 1602-3 .
  8. Mercier FJ, Dounas M, Bouaziz H et al. The effect of adding a minidose of clonidine to intrathecal sufentanil for labor analgesia. Anesthesiology 1998;89: 594-601.
  9. Sia AT. Optimal dose of intrathecal clonidine added to sufentanil plus bupivacaine for labor analgesia. Can J Anesth 2000;47: 875- 80.
  10. D'Angelo R, Evans E, Dean LA, Gaver R, Eisenach JC. Spinal clonidine prolongs labor analgesia from spinal sufentanil and bupivacaine. Anesth Analg 1999; 88:573-6.
  11. Missant C, Teunkens A, Vandermeersch E, Van de Velde M. Intrathecal clonidine prolongs labor analgesia but worsens fetal outcome: a pilot study. Can J Anesth 2004; 51: 696-701.
  12. Owen MD, Ozsaraç O, Sahin S, Uçkunkaya N, Kaplan N, Magunaci I. Low-dose Clonidine and Neostigmine Prolong the Duration of Intratbecal Bupivacaine-Fentanyl for Labor Analgesia. Anesthesiology 2000; 92: 361-6.
  13. Bonnet F, Buisson VB, François Y, Catoire P, Saada M. Effects of oral and subarachnoid clonidine on spinal anesthesia with bupivacaïne. Reg Anesth 1990; 15: 211-4.
  14. Walter SM, Goudas LC, Cousins MJ, Carr DB. Combination spinal analgesic chemotherapy. A systematic review. Anesth Analg 2003;95: 674-715.
  15. Paech MJ, Banks SL, Gurrin LC, Yeo ST, Pavy TJ. A randomized, double-blinded trial of subarachnoid bupivacaine and fentanyl, with or without clonidine, for combined spinal/epidural analgesia during labor. Anesth Analg 2002;95:1396-401.
  16. Eisenach JC, Hood DD, Curry R. Relative potency of epidural to intrathecal clonidine differs between acute thermal pain and capsaicin-induced allodynia. Pain 2000; 84:57-64.
  17. Collis RE, Davies DW, Aveling W. Randomised comparison of combined spinal epidural and standard epidural analgesia during labour. Lancet 1995;345:1413-6.
  18. D'Angelo R, Anderson MT, Philip J, Eisenach JC. Intrathecal sufentanil compared to epidural bupivacaine for labor analgesia. Anesthesiology 1994; 80: 1209-15.
  19. Stacey RG, Watt S, Kadim MY, Morgan BM. Single space combined spinal-extradural technique for analgesia in labour. Br J Anaesth 1993;71:499-502.
  20. Riley ET, Walker D, Hamilton CL, Cohen SE. Intrathecal sufentanil for labor analgesia does not cause a sympathectomy. Anesthesiology 1997; 87: 874-8.
  21. De Kock M, Meert TF. Alpha 2-adrenoceptor agonists and stress induced analgesia in rats : influence of stressors and methods of analysis. Pharmacol Biochem Behav 1997; 58: 109-17.
  22. Chiari C, Lorber C, Eisenach JC et al. Analgesic and hemodynamic eflects of intrathecal clonidine as the sole analgesic agent during first stage of labor. Anesthesiology 1999;91:388-96.
  23. Campbell DC, Camann WR, Datta S. The addition of bupivacaine to intrathecal sufentanil for labor analgesia. Anesth Analg 1995;81:305-9.
  24. Collis RE, Baxandal ML, Srikantharajah ID, Edge G, Kadim MY,Morgan BM. Combined spinal epidural analgesia: technique, management and outcome of 300 mothers. Int J Obstet Anesth 1994;3:75-81.
  25. Abouleish E, Rawal N, Shaw J, Lorenz T, Rashad MN. Intrathecal morphine 0.2 mg versus epidural bupivacaine 0.125% or their combination: effects on parturients. Anesthesiology 1991;74:711- 6.
  26. Clarke VT, Smiley RM, Finster M. Uterine hyperactivity after intrathécal injection of fentanyl for analgesia during labor: a cause of fetal bradycardia? Anesthesiology 1994;81:1083.
  27. Kuczkowski KM. Severe persistent fetal bradycardia following subarachnoid administration of fentanyl and bupivacaine for induction of a combined spinal-epidural analgesia for labor pain.J Clin Anesth 2004; 16: 78-9.
  28. Thimons J, Laifer S, Ramanathan S. Intravenous fluid bolus modifies the effects of intrathécal fentanyl on uterine activity. Anesthesiology 1996;85:A853.
  29. Segal S, Csavoy A, Datta S. The tocolytic effect of catecholamines in the gravid rat uterus. Anesth Analg 1998; 87: 864-9.
  30. Mercier FJ, Donnas M, Bouaziz H, Lhuissier C, Benhamou D. Intravenous nitroglycerin to relieve intrapartum fetal distress related to utérine hyperactivity. A prospective observational study. Anesth Analg1997;84:1117-20.