Document Detail


Intrathecal clonidine prolongs labour analgesia but worsens fetal outcome: a pilot study.
MedLine Citation:
PMID:  15310638     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: 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). CONCLUSION: 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.
Authors:
Carlo Missant; An Teunkens; Eugene Vandermeersch; Marc Van de Velde
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  51     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:    2004 Aug-Sep
Date Detail:
Created Date:  2004-08-16     Completed Date:  2005-03-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  696-701     Citation Subset:  IM    
Affiliation:
Director Obstetric Anesthesia and Extra Muros Anesthesia, Department of Anesthesiology, University Hospitals Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
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MeSH Terms
Descriptor/Qualifier:
Adult
Amides / therapeutic use
Analgesia, Obstetrical / adverse effects*,  methods
Analgesics / administration & dosage,  adverse effects,  pharmacology
Anesthetics, Intravenous / therapeutic use
Anesthetics, Local / therapeutic use
Apgar Score*
Blood Pressure / drug effects
Clonidine / administration & dosage,  adverse effects*,  pharmacology*
Double-Blind Method
Drug Synergism
Drug Therapy, Combination
Female
Heart Rate, Fetal / drug effects*
Humans
Infant, Newborn
Injections, Spinal / methods
Labor Pain / drug therapy*
Pain Measurement / methods
Pilot Projects
Pregnancy
Sufentanil / therapeutic use
Time Factors
Umbilical Arteries / drug effects
Chemical
Reg. No./Substance:
0/Amides; 0/Analgesics; 0/Anesthetics, Intravenous; 0/Anesthetics, Local; 4205-90-7/Clonidine; 56030-54-7/Sufentanil; 84057-95-4/ropivacaine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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