British Journal of Anaesthesia, Vol 77, Issue 4 458-462, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
D. Chassard, L. Mathon, F. Dailler, F. Golfier, J. P. Tournadre and P. Bouletreau
We have studied the use of clonidine combined with low doses of sufentanil
and bupivacaine in 45 parturients requiring extradural analgesia for the
first stage of labour, in a double-blind, randomized study. We gave 0.0625%
bupivacaine 10 ml containing 1:200,000 adrenaline and sufentanil 10
micrograms (1 ml) to which was added 0.9% saline, or clonidine 100 or 150
micrograms (1 ml). We compared the quality (VAS scores) and duration of
analgesia, motor block, maternal haemodynamic state (mean arterial pressure
and heart rate) and fetal and maternal side effects. Mean duration of
anaesthesia was prolonged slightly: 105 (SD 21) min without clonidine, 130
(26) min with clonidine 100 micrograms (P < 0.05 vs control) and 144
(40) min with clonidine 150 micrograms (P < 0.01 vs control, ns vs 100
micrograms). There were no differences in VAS scores, onset times, heart
rate, ventilatory frequency, motor block, sedation, pruritus or bradycardia
between the groups. Analgesia was associated with a reduction in mean
arterial pressure with clonidine. However, these adverse side effects were
of minor clinical importance regardless of the extradural clonidine dose,
except for a high incidence of fetal heart tracing abnormalities when
clonidine 150 micrograms was used. These effects associated with a limited
effect on analgesia may curtail the widespread use of clonidine as an
adjunct to extradural 0.0625% bupivacaine with sufentanil 10 micrograms
during labour.
CLINICAL INVESTIGATIONS
Extradural clonidine combined with sufentanil and 0.0625% bupivacaine for analgesia in labour
Service d'Anesthesie-Reanimation, Hopital de l'Hotel-Dieu, 69002 Lyon, France; Service de Gynecologie-Obstetrique, Hopital de l'Hotel-Dieu, 69002 Lyon, France
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