Intrathecal clonidine prolongs labour analgesia but worsens fetal outcome: a pilot study.
OBJECTIVE
Intrathecal clonidine prolongs total duration of spinal bupivacaine analgesia. However, there are contradictory reports about its effect on maternal blood pressure and only limited data are available on fetal and neonatal outcome. In this study, we evaluated the efficacy of spinal clonidine combined with ropivacaine and sufentanil and its effects on maternal and fetal outcome.


METHODS
Fifty patients requesting combined spinal epidural analgesia for labour pain relief were randomly assigned to receive intrathecal ropivacaine 3 mg, sufentanil 1.5 microg with or without clonidine 30 microg. Onset time and duration of analgesia, visual analogue scores for pain, blood pressure, ephedrine requirements, heart rate, incidence of nausea, pruritus and motor blockade, umbilical artery pH, fetal heart rate abnormalities and Apgar scores were noted and analyzed.


RESULTS
Patients receiving spinal clonidine had significantly longer lasting analgesia compared to patients treated without clonidine (122 +/- 56 min vs 90 +/- 36 min, P < 0.05). Clonidine-treated patients experienced a more pronounced decrease in mean arterial pressure as compared to patients treated without clonidine (25 +/- 10% vs 15 +/- 12%, P < 0.05). The groups also differed in ephedrine requirement (4.91 mg vs 0.75 mg, P < 0.05), number of new onset fetal heart rate abnormalities (28% vs 0%, P < 0.05) and umbilical artery pH (7.219 +/- 0.096 vs 7.289 +/- 0.085, P < 0.05).


CONCLUSIONS
Intrathecal clonidine prolongs spinal analgesia with ropivacaine and sufentanil at the expense of maternal hypotension, worse fetal well being and worse neonatal umbilical artery pH. We do not recommend routine administration of spinal clonidine 30 microg to sufentanil and ropivacaine for labour pain relief.
Missant
Carlo
C
Director Obstetric Anesthesia and Extra Muros Anesthesia, Department of Anesthesiology, University Hospitals Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Teunkens
An
A
Vandermeersch
Eugene
E
Van de Velde
Marc
M
D000328:Adult; D000577:Amides / Q000627:therapeutic use; D016362:Analgesia, Obstetrical / Q000009:adverse effects* / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D001034:Apgar Score; D001794:Blood Pressure / Q000187:drug effects; D003000:Clonidine / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology*; D004311:Double-Blind Method; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006340:Heart Rate, Fetal / Q000187:drug effects*; D006801:Humans; D007231:Infant, Newborn; D007278:Injections, Spinal / Q000379:methods; D048949:Labor Pain / Q000188:drug therapy*; D010147:Pain Measurement / Q000379:methods; D010865:Pilot Projects; D011247:Pregnancy; D000077212:Ropivacaine; D017409:Sufentanil / Q000627:therapeutic use; D013997:Time Factors; D014469:Umbilical Arteries / Q000187:drug effects
D000577:Amides; D000700:Analgesics; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000077212:Ropivacaine; D017409:Sufentanil; D003000:Clonidine