[en] BACKGROUND: Sufentanil 5 microg and clonidine 75 microg produce a similar reduction in minimum local anaesthetic concentration of ropivacaine. The aim of the present study was to compare the side effects of two equianalgesic solutions by combining 0.2% ropivacaine with either sufentanil 5 microg or clonidine 75 microg for labour epidural analgesia. METHODS: In a prospective double-blind study, 60 women at 5 cm cervical dilatation were randomly allocated to receive 0.2% ropivacaine with either sufentanil 5 microg or clonidine 75 microg to initiate labour analgesia. The analgesic efficacy and side effects of the two mixtures were compared. RESULTS: Onset, duration and quality of analgesia and subsequent ropivacaine consumption were similar in the two groups. Hypotension was significantly more frequent and severe with clonidine than with sufentanil (systolic blood pressure <100 mmHg: 17/26 vs. 6/24, P <0.05; systolic blood pressure <90 mmHg: 5/26 vs. 0/24, P <0.05) resulting in more frequent ephedrine administration (11/26 vs. 2/24, P <0.05) and larger fluid requirements (1696 +/- 583 mL vs. 1264 +/- 407 mL, P < 0.05). Conversely, pruritus was more frequent with sufentanil than with clonidine (6/26 vs. 1/24, P <0.05). CONCLUSIONS: Hypotension occurs more frequently when clonidine is added to epidural ropivacaine instead of an equianalgesic dose of sufentanil. Therefore, clonidine cannot be recommended for routine administration for labour epidural analgesia.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Dewandre, Pierre-Yves ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Decurninge, Valérie
Bonhomme, Vincent ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Hans, Pol ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Brichant, Jean-François ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Language :
English
Title :
Side effects of the addition of clonidine 75 microg or sufentanil 5 microg to 0.2% ropivacaine for labour epidural analgesia.
Chestnut D.H., Owen C.L., Bates J.N., Ostman L.G., Choi W.W., and Geiger M.W. Continuous infusion epidural analgesia during labor: a randomized, double-blinded comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine. Anesthesiology 68 (1988) 754-759
Vertommen J.D., Vandermeulen E., Van Aken H., et al. The effects of the addition of sufentanil to 0.125% bupivacaine on the quality of analgesia during labor and on the incidence of instrumental deliveries. Anesthesiology 74 (1991) 809-814
Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial. Lancet 2001;358:19-23.
Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK. Randomized controlled trial comparing traditional with two "mobile" epidural techniques. Anesthetic and analgesic efficacy. Anesthesiology 2002;97:1567-75.
Burnstein R., Buckland R., and Pickett J.A. A survey of epidural analgesia for labour in the United Kingdom. Anaesthesia 54 (1999) 634-640
O'Meara M.E., and Gin T. Comparison of 0.125% bupivacaine with 0.125% bupivacaine and clonidine as extradural analgesia in the first stage of labour. Br J Anaesth 71 (1993) 651-656
Le Polain B., De Kock M., Scholtes J.L., and Van Lierde M. Clonidine combined with sufentanil and bupivacaine with adrenaline for obstetric analgesia. Br J Anaesth 71 (1993) 657-660
Celleno D., Capogna G., Costantino P., and Zangrillo A. Comparison of fentanyl with clonidine as adjuvants for epidural analgesia with 0.125% bupivacaine in the first stage of labor. Int J Obstet Anesth 4 (1995) 26-29
Cigarini I., Kaba A., Bonnet F., et al. Epidural clonidine combined with bupivacaine for analgesia in labor. Effects on mother and neonate. Reg Anesth 20 (1995) 113-120
Chassard D., Mathon L., Dailler F., Golfier F., Tournade J.P., and Bouletreau P. Extradural clonidine combined with sufentanil and 0.0625% bupivacaine for analgesia in labour. Br J Anaesth 77 (1996) 458-462
Eisenach J.C., De Kock M., and Klimscha W. Alpha2-adrenergic agonists for regional anaesthesia: a clinical review of clonidine (1984-1995). Anesthesiology 85 (1996) 655-674
Claes B., Soetens M., Van Zundert A., and Datta S. Clonidine added to bupivacaine-epinephrine-sufentanil improves epidural analgesia during childbirth. Reg Anesth Pain Med 23 (1998) 540-547
Tremlett M.R., Kelly P.J., Parkins J., Hughes D., and Redfern N. Low-dose clonidine infusion during labour. Br J Anaesth 83 (1999) 257-261
Paech M.J., Pavy T.J., Orlikowski C.E., and Evans S.F. Patient-controlled epidural analgesia in labor: the addition of clonidine to bupivacaine-fentanyl. Reg Anesth Pain Med 25 (2000) 34-40
Kizilarslan S., Kuvaki B., Onat U., and Sagiroglu E. Epidural fentanyl-bupivacaine compared with clonidine-bupivacaine for analgesia in labour. Eur J Anaesthesiol 17 (2000) 692-697
Landau R., Schiffer E., Morales M., Savoldelli G., and Kern C. The dose-sparing effect of clonidine added to ropivacaine for labor epidural analgesia. Anesth Analg 95 (2002) 728-734
Aveline C., El Metaoua S., Masmoudi A., Boelle P.Y., and Bonet F. The effect of clonidine on the minimum local analgesic concentration of epidural ropivacaine during labor. Anesth Analg 95 (2002) 735-740
Lyons G., Columb M., Hawthorne L., and Dresner M. Extradural pain relief in labour: bupivacaine sparing by extradural fentanyl is dose dependent. Br J Anaesth 78 (1997) 493-497
Polley L.S., Columb M.O., Wagner D.S., and Naughton N.N. Dose-dependent reduction of the minimum local analgesic concentration of bupivacaine by sufentanil for epidural analgesia in labor. Anesthesiology 89 (1998) 626-632
Bernard J.M., Le Roux D., Barthe A., Jourdain O., Vizquel L., and Michel C. The dose-range effects of sufentanil added to 0.125% bupivacaine on the quality of patient-controlled epidural analgesia during labor. Anesth Analg 92 (2001) 184-188
Dewandre P.Y., Kirsch M., Bonhomme V., Columb M., Hans P., and Brichant J.F. Impact of the addition of sufentanil 5 μg or clonidine 75 μg on the minimum local analgesic concentration of ropivacaine for epidural analgesia in labour: a randomized comparison. Int J Obstet Anesth 17 (2008) 315-321
Debon R., Allaouchiche B., Duflo F., Boselli E., and Chassard D. The analgesic effects of sufentanil combined with ropivacaine 0.2% for labor analgesia: a comparison of three sufentanil doses. Anesth Analg 92 (2001) 180-183
Benhamou D., Mercier F.J., Ben Ayed M., and Auroy Y. Continuous epidural analgesia with bupivacaine 0.125% or bupivacaine 0.0625% plus sufentanil 0.25 μg/ml: a study in singleton breech presentation. Int J Obstet Anesth 11 (2002) 13-18
Beilin Y., Galea M., and Bodian C.A. Epidural ropivacaine for the initiation of labor epidural analgesia: a dose finding study. Anesth Analg 88 (1999) 1340-1345
Paech M.J. Patient-controlled epidural analgesia in labour: is a continuous infusion of benefits?. Anaesth Intensive Care 20 (1992) 15-20
Boselli E., Debon R., Cimino Y., Rimmelé T., Allaouchiche B., and Chassard D. Background infusion is not beneficial during labor patient-controlled analgesia with 0.1% ropivacaine plus 0.5 μg/ml sufentanil. Anesthesiology 100 (2004) 968-972
Bremerich D., Waibel H.J., Mierdl S., et al. Comparison of continuous background infusion plus demand dose and demand-only parturient-controlled epidural analgesia using ropivacaine combined with sufentanil for labor and delivery. Int J Obstet Anesth 14 (2005) 114-120
Missant C., Teunkenst A., Vandermeersch E., and Van de Velde M. Patient-controlled epidural analgesia following combined spinal-epidural analgesia in labour: the effects of adding a continuous epidural infusion. Anaesth Intensive Care 33 (2005) 452-456
Cooper D.W., Carpenter M., Mowbray P., Desira W.R., Ryall D.M., and Kokri M.S. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for caesarean delivery. Anesthesiology 97 (2002) 1582-1590
Missant C., Teunkens A., Vandermeersch E., and Van de Velde M. Intrathecal clonidine prolongs labour analgesia but worsens fetal outcome: a pilot study. Can J Anesth 51 (2004) 696-701
