title: Extradural analgesia with clonidine and fentanyl compared with 0.25% bupivacaine in the first stage of labour.
abstract: 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.
authors.affiliation: Department of Anaesthesia, International Missionary Training Hospital, Drogheda, Ireland.
authors.forename: D J
authors.initials: DJ
authors.lastname: Buggy
authors.forename: C
authors.initials: C
authors.lastname: MacDowell
mesh_terms: D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002045:Bupivacaine; D003000:Clonidine; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005283:Fentanyl; D006801:Humans; D007747:Labor Stage, First; D011247:Pregnancy; D013565:Sympatholytics
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004338:Drug Combinations; D013565:Sympatholytics; D003000:Clonidine; D005283:Fentanyl; D002045:Bupivacaine