[Combined spinal and epidural analgesia for labor. Prolongation by addition of a minidose of clonidine to sufentanil. An initial study].
The effect of adding a minidose of clonidine to intrathecal sufentanil during the early first stage of a painful labour was evaluated in this preliminary open-label, non-randomised trial. Group 1 received sufentanil 5 micrograms + clonidine 30 micrograms intrathecally (n = 10) and group 2 only intrathecal sufentanil 5 micrograms (n = 11). The two groups were not statistically different regard-ing age, weight, height, primiparity (67 vs 50%), oxytocin use (37 vs 60%), initial cervical dilation (m +/- DS: 2.9 +/- 1.1 vs 2.9 +/- 1 cm) and VAS pain scores (70 +/- 14 vs 68 +/- 19 mm). In group 1, analgesia was markedly prolonged with a reduced variability in duration: 146 +/- 27 min vs 95 +/- 44 min, (P = 0.006). VAS pain scores were: 14 +/- 20 vs 19 +/- 13, 1 +/- 3 vs 9 +/- 12, 0 vs 5 +/- 7, 48 +/- 12 vs 65 +/- 15, five and fifteen minutes after intrathecal injection, during maximum efficacy, and at the time additional analgesia was required, in group 1 and group 2, respectively. Analgesia evaluated with the VAS pain scores was better in group 1 compared with group 2 (P = 0.02) and decreased somewhat slower. Side effects, such as hypotension, pruritus and sedation, were not statistically different between groups. Nausea and motor blockade did not occur. In conclusion, the addition of a minidose (30 micrograms) of clonidine to sufentanil 5 micrograms given intrathecally seems to potentiate markedly the analgesia obtained during the early first stage of labour.
Mercier
F J
FJ
Département d'anesthésie-réanimation, hôpital Antoine-Béclère, Clamar, France.
Boulay
G
G
Ben Ayed
M
M
Benhamou
D
D
D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000767:Anesthesia, Epidural / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D003000:Clonidine / Q000008:administration & dosage; D004338:Drug Combinations; D004357:Drug Synergism; D005260:Female; D006801:Humans; D011247:Pregnancy; D017409:Sufentanil / Q000008:administration & dosage
D000701:Analgesics, Opioid; D004338:Drug Combinations; D017409:Sufentanil; D003000:Clonidine
Analgésie rachidienne et péridurale combinée pour le travail. Prolongation par l'adjonction d'une minidose de clonidine au sufentanil. Etude préliminaire.