title: Low-dose clonidine and neostigmine prolong the duration of intrathecal bupivacaine-fentanyl for labor analgesia.
abstract: BACKGROUND
  Intrathecal (IT) opioid and local anesthetic combinations are popular for labor analgesia because of rapid, effective pain relief, but the duration of analgesia is limited. This study was undertaken to determine whether the addition of clonidine and neostigmine to IT bupivacaine-fentanyl would increase the duration of analgesia without increasing side effects for patients in labor.
  
  
  METHODS
  Forty-five healthy parturients in active labor were randomized to receive a 2-ml IT dose of one of the following dextrose-containing solutions using the combined spinal-epidural technique: (1) bupivacaine 2.5 mg and fentanyl 25 microg (BF); (2) BF plus clonidine 30 microg (BFC); or (3) BFC plus neostigmine 10 microg (BFCN). Pain, sensory levels, motor block, side effects, maternal vital signs, and fetal heart rate were systematically assessed.
  
  
  RESULTS
  Patients administered BFCN had significantly longer analgesia (165+/-32 min) than those who received BF (90+/-21 min; P<0.001) or BFC (123+/-21 min; P<0.001). Pain scores, block characteristics, maternal vital signs, Apgar scores, maternal satisfaction, and side effects were similar among groups except for nausea, which was significantly greater in the BFCN group (P<0.05 as compared with BFC).
  
  
  CONCLUSIONS
  The addition of clonidine and neostigmine significantly increased the duration of analgesia from IT bupivacaine-fentanyl during labor, but neostigmine caused more nausea. Although serious side effects were not observed in this study, safety must be further addressed before the routine use of multiple IT drugs is advocated.
authors.affiliation: Wake Forest University Department of Anesthesiology, Section on Obstetric Anesthesia, Winston-Salem, North Carolina, USA. mowen@wfubmc.edu
authors.forename: M D
authors.initials: MD
authors.lastname: Owen
authors.forename: O
authors.initials: O
authors.lastname: Ozsaraç
authors.forename: S
authors.initials: S
authors.lastname: Sahin
authors.forename: N
authors.initials: N
authors.lastname: Uçkunkaya
authors.forename: N
authors.initials: N
authors.lastname: Kaplan
authors.forename: I
authors.initials: I
authors.lastname: Magunaci
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000009:adverse effects; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D016362:Analgesia, Obstetrical; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D001034:Apgar Score; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D003000:Clonidine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007231:Infant, Newborn; D007278:Injections, Spinal; D009388:Neostigmine / Q000008:administration & dosage / Q000009:adverse effects; D010147:Pain Measurement / Q000187:drug effects; D017060:Patient Satisfaction; D011247:Pregnancy
chemical_list: D000759:Adjuvants, Anesthesia; D000316:Adrenergic alpha-Agonists; D000779:Anesthetics, Local; D002800:Cholinesterase Inhibitors; D009388:Neostigmine; D003000:Clonidine; D005283:Fentanyl; D002045:Bupivacaine