title: Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine.
abstract: BACKGROUND
  Feeling of pain is one of the most important emotional determinants which dominate the perception of females who undergo the process of labour and delivery. Patient controlled epidural labour analgesia (PCEA) is convenient and safer technique for this purpose. Very few studies compared clonidine and fentanyl with ropivacaine in labour analgesia in past. This study was undertaken to compare fentanyl and clonidine in PCEA.
  
  
  OBJECTIVE
  To compare low concentration ropivacaine with or without fentanyl or clonidine for labour analgesia and its effect on maternal and foetal safety.
  
  
  METHODS
  Prospective, double blind, randomized, comparative study.
  
  
  METHODS
  Ninety primegravida in labour were divided into three groups (n=30) and patient controlled epidural labour analgesia was given to them: Initial bolus of 10ml of ropivacaine 0.125% in Group I; with fentanyl 2 μg/ml in Group II and with clonidine 1μg/kg in Group III. Subsequently each group received ropivacaine 0.125% through patient controlled epidural analgesia (PCEA) as background infusion of 5 ml/hr with lockout interval time of 10min and subsequent bolus of 5ml. Hemodynamic parameters, sensory level, motor block and pain relief were noted. Total analgesic dose of local anaesthetic and feto-maternal adverse effects were also recorded.
  
  
  RESULTS
  At baseline, groups were matched demographically, hemodynamically as well as for intensity of pain. There was a statistically significant decrease in hemodynamic parameters from baseline in all groups with maximum reduction in group III. A significant difference among groups in VAS was observed at zero min and from 120min till 240min intervals and lowest values were in Group III. No significant difference was observed among the groups for mode of delivery and expulsive efforts. Total analgesic dose and PCA bolus requirement was maximum in Group I and minimum in Group III and the difference was statistically significant among groups. Six (20%) patients had shivering in Group II and hypotension was recorded in only 1 (3.3%) patient of Group III.
  
  
  CONCLUSIONS
  Ropivacaine 0.125% was effective in decreasing labour pain without any motor blockade. Clonidine 1μg/kg was superior to fentanyl 2μg/ml as an adjuvant in PCEA for labour without any significant feto-maternal adverse effects.
authors.affiliation: Junior Resident, Department of Anaesthesiology, K.G.'s Medical University , Lucknow (U.P.), India .
authors.forename: Arun
authors.initials: A
authors.lastname: Ahirwar
authors.affiliation: Senior Resident, Department of Anaesthesiology, K.G.'s Medical University , Lucknow (U.P.), India .
authors.forename: Ravi
authors.initials: R
authors.lastname: Prakash
authors.affiliation: Assistant Professor, Department of Anaesthesiology, K.G.'s Medical University , Lucknow (U.P.), India .
authors.forename: Brij Bihari
authors.initials: BB
authors.lastname: Kushwaha
authors.affiliation: Senior Resident, Department of Anaesthesiology, K.G.'s Medical University , Lucknow (U.P.), India .
authors.forename: Amrita
authors.initials: A
authors.lastname: Gaurav
authors.affiliation: Associate Professor, Department of Anaesthesiology, K.G.'s Medical University , Lucknow (U.P.), India .
authors.forename: Ajay Kumar
authors.initials: AK
authors.lastname: Chaudhary
authors.affiliation: Assistant Professor, Department of Anaesthesiology, K.G.'s Medical University , Lucknow (U.P.), India .
authors.forename: Reetu
authors.initials: R
authors.lastname: Verma
authors.affiliation: Professor, Department of Anaesthesiology, K.G.'s Medical University , Lucknow (U.P.), India .
authors.forename: Dinesh
authors.initials: D
authors.lastname: Singh
authors.affiliation: Professor, Department of Anaesthesiology, K.G.'s Medical University , Lucknow (U.P.), India .
authors.forename: Vineeta
authors.initials: V
authors.lastname: Singh
keywords: Clonidine; Fentanyl; Labour analgesia; PCEA; Ropivacaine