British Journal of Anaesthesia, Vol 76, Issue 2 319-321, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
D. J. Buggy and C. MacDowell
Conventional extradural analgesia during labour with 0.25-0.375%
bupivacaine may induce motor weakness and subjective sensory deficit,
reducing maternal satisfaction. Even in a regimen for ambulatory extradural
analgesia (0.1% bupivacaine-fentanyl 2 micrograms ml-1), a potential for
proprioreception impairment exists, which may impair safe ambulation. We
have combined fentanyl with clonidine for extradural analgesia in labour,
and compared its effects with 0.25% bupivacaine, in a randomized,
double-blind study. We studied 28 women requesting extradural analgesia for
labour; they were allocated randomly to either group 1, who received
clonidine 120 micrograms with fentanyl 50 micrograms, or group 2, who
received bupivacaine 25 mg. Detailed clinical neurological examination was
undertaken 30 min later. Pain was assessed subjectively using a 10-cm
visual analogue scale (VAS). There were no significant differences in VAS
between the groups at any time. Median onset of analgesia was longer in
group 1 (24.3 (interquartile range 20-35) compared with 17.5 (15-25) min)
(P < 0.05) and 79% of group 1 vs 86% of group 2 patients reported a high
degree of satisfaction with extradural analgesia. Patients in group 2 had a
much higher incidence of motor weakness (P < 0.01), impaired perception
of pinprick (P < 0.01) and impaired distal joint proprioception (P <
0.05) than group 1. We conclude that clonidine 120 micrograms-fentanyl 50
micrograms provided comparable extradural analgesic efficacy as 0.25%
bupivacaine for the first stage of labour. Furthermore, unwanted
neurological effects were significantly less.
SHORT COMMUNICATIONS
Extradural analgesia with clonidine and fentanyl compared with 0.25% bupivacaine in the first stage of labour
Department of Anaesthesia, International Missionary Training Hospital, Drogheda, County Louth, Ireland
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