title: Patient-controlled epidural analgesia in labor: the addition of clonidine to bupivacaine-fentanyl.
abstract: OBJECTIVE
  Epidural clonidine has not been evaluated as a component of patient-controlled epidural analgesia (PCEA) solutions during labor. A randomized, double-blind trial was conducted to investigate the efficacy and side effects of PCEA using bupivacaine and fentanyl, with or without clonidine.
  
  
  METHODS
  Seventy-five healthy parturients in active labor were assigned to a PCEA solution of 0.0625% bupivacaine and fentanyl 2 microg/mL (4 mL demand bolus, 15 min lockout), with or without clonidine 4.5 microg/mL. The primary outcome measure was parturient rating of analgesia; others assessments included pain scores, drug utilization, supplementation and side effects.
  
  
  RESULTS
  Thirty-one parturients received clonidine (group BFC) and 38 received control solution (group BF). Eight (6 group BF, 2 group BFC, P = .28) failed to achieve satisfactory epidural analgesia. There was a trend for parturient ratings of pain relief to be higher in group BFC, with significantly more reporting excellent first-stage analgesia (81% v. 57%, P<.05). Pain scores were similar. Clonidine (median dose, 28 microg/h) reduced total bupivacaine and fentanyl use (P<.01), and reduced supplementation (P<.01). Maternal blood pressure (BP) and recordings of systolic BP below 100 mm Hg did not differ. Group BFC had higher sedation scores (P<.01), but no one appeared oversedated. Shivering was reduced in group BFC (P<.01).
  
  
  CONCLUSIONS
  The addition of clonidine to epidural bupivacaine and fentanyl for PCEA in labor improved analgesia, reduced the supplementation rate, and reduced shivering. Increased sedation and lower BP were not clinically important.
authors.affiliation: Department of Anaesthesia, King Edward Memorial Hospital for Women, Subiaco, Western Australia. michael.paech@health.wa.gov.au
authors.forename: M J
authors.initials: MJ
authors.lastname: Paech
authors.forename: T J
authors.initials: TJ
authors.lastname: Pavy
authors.forename: C E
authors.initials: CE
authors.lastname: Orlikowski
authors.forename: S F
authors.initials: SF
authors.lastname: Evans
mesh_terms: D000759:Adjuvants, Anesthesia / Q000009:adverse effects; D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D000779:Anesthetics, Local / Q000009:adverse effects; D002045:Bupivacaine / Q000009:adverse effects; D003000:Clonidine / Q000009:adverse effects; D036861:Delivery, Obstetric; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D010147:Pain Measurement; D011247:Pregnancy; D018401:Sample Size
chemical_list: D000759:Adjuvants, Anesthesia; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D003000:Clonidine; D005283:Fentanyl; D002045:Bupivacaine