title: Effects of epidural neostigmine and clonidine in labor analgesia: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the effect and quality of epidural neostigmine and clonidine added to initial spinal analgesia in labor analgesia.
  
  
  METHODS
  A systematic search was conducted in the Medline, Embase, Cochrane Library and China National Knowledge Infrastructure electronic databases. Case-control studies reporting epidural administration of neostigmine and clonidine for labor analgesia were retrieved. For continuous variables, mean differences (MD) and 95% confidence intervals (CI) were calculated; for binary classification variables, odds ratio (OR) and risk ratios (RR) with their 95% CI were analyzed.
  
  
  RESULTS
  A total of four case-control studies, including 280 parturients, were identified in this meta-analysis. The results showed that epidural clonidine and neostigmine significantly prolonged initial analgesia (MD = 37.79, 95% CI = 9.37-66.21, P = 0.0.009) and reduced hourly local anesthetics and opioid administration (MD = -5.49, 95% CI = -6.78, -4.21, P < 0.0001). There was no significant difference in total duration of labor, mode of delivery (cesarean section rate or instrumental delivery rate) and Apgar scores of the neonates in the two groups.
  
  
  CONCLUSIONS
  Epidural administration of neostigmine and clonidine, following the spinal injection of local anesthetic, has a stronger analgesic effect in managing labor pain and reduces hourly anesthetic consumption. No obvious adverse reactions were found.
authors.affiliation: Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Zhang
authors.forename: Ming-jun
authors.initials: MJ
authors.lastname: Xu
mesh_terms: D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001034:Apgar Score; D003000:Clonidine / Q000008:administration & dosage*; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D048949:Labor Pain / Q000188:drug therapy; D009388:Neostigmine / Q000008:administration & dosage*; D010147:Pain Measurement; D011247:Pregnancy
chemical_list: D000779:Anesthetics, Local; D009388:Neostigmine; D003000:Clonidine
keywords: clonidine; combined spinal-epidural; labor analgesia; meta-analysis; neostigmine