Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: A randomized controlled trial

Li, Gehui; Xiao, Yuci; Qi, Xiaofei; Wang, Hao; Wang, Xiaoguang; Sun, Jing; Yong, Li; Li, Yuantao

doi:10.3892/etm.2020.8730

“…Comparison of our present data with other literature is rather difficult, as most of the published studies have studied the two adjuvants separately using different drug administration protocols or concentrations. However, similar trends were seen in studies based on dexmedetomidine as well as clonidine [15][16][17][18].…”

Section: Discussionsupporting

confidence: 74%

A Comparison Between Dexmedetomidine and Clonidine as Adjuvants to Levobupivacaine in Labour Analgesia

Kabi¹,

Verma²,

Singh³

et al. 2021

Cureus

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BackgroundThe epidural analgesia technique is effective for labor analgesia and combinations of various local anesthetics with lipophilic opioids like fentanyl are used. However, fentanyl can cause an increased incidence of pruritus, urinary retention, nausea, vomiting, giddiness, shivering, and respiratory depression. Dexmedetomidine and clonidine are selective alpha 2 agonists with analgesic properties and have been used via the neuraxial route with local anesthetics for the same without the side effects of fentanyl. Thus, the primary objective was to assess and compare the analgesic efficacy of the two-drug combinations by the visual analog scale (VAS) score. MethodsFifty-four primigravida women were randomly allocated in two groups of 27 each and were given an initial bolus of 10 mL of 0.125% levobupivacaine with dexmedetomidine 0.5 ug/kg in Group A and with clonidine 1 μg/kg in Group B. Subsequently, each patient received a background infusion rate of 10 mL/h, a bolus dose of 5 ml, and a lock-out interval of 10 min via a patient-controlled-analgesia (PCA) pump. The blood pressure, heart rate, and severity of pain using VAS were assessed. Durations of the stages of labor, rate of instrumental delivery, and cesarean section, side effects, maternal sedation, and neonatal Apgar scores were also recorded. ResultsVAS scores in both the groups progressively decreased to <3 by 15 min with significant differences at five, 10, 15, and 120 min being lower in group A. Onset of analgesia and time for maximum analgesia was significantly shorter in group A. There was a significant decrease in hemodynamic parameters from baseline in both groups. The fall in heart rate was significantly greater in Group A and at almost all the time intervals after baseline, diastolic blood pressure (DBP) was also lower in group A. Maternal motor blockade scores, the intensity of maternal sedation, the incidence of maternal complications, the duration of the first and second stage of labor, the rate of instrumental delivery and cesarean section, total analgesic dose and PCA bolus requirement, and neonatal Apgar scores did not show a significant difference between the two groups. ConclusionBoth dexmedetomidine and clonidine provide hemodynamically stable labor with a fall in heart rate and maternal blood pressure in the initial hours. Dexmedetomidine has the advantage of faster onset of analgesia and time for maximum analgesia.

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“…Eight RCTs assessing ropivacaine were carried out in China [ 3 , 11 , 22 – 27 ], and one assessing bupivacaine was carried out in Egypt [ 21 ]. Five studies [ 3 , 11 , 22 , 25 , 27 ] compared dexmedetomidine with placebo, one [ 21 ] compared dexmedetomidine with fentanyl, and three [ 23 , 24 , 26 ] compared dexmedetomidine with sufentanil. Six RCTs [ 3 , 22 – 26 ] used 0.5 μ g/mL dexmedetomidine, one [ 11 ] used 0.5 μ g/kg dexmedetomidine, one [ 21 ] used 1 μ g/kg dexmedetomidine, and one [ 27 ] used four concentrations of dexmedetomidine.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies [ 3 , 11 , 22 , 25 , 27 ] compared dexmedetomidine with placebo, one [ 21 ] compared dexmedetomidine with fentanyl, and three [ 23 , 24 , 26 ] compared dexmedetomidine with sufentanil. Six RCTs [ 3 , 22 – 26 ] used 0.5 μ g/mL dexmedetomidine, one [ 11 ] used 0.5 μ g/kg dexmedetomidine, one [ 21 ] used 1 μ g/kg dexmedetomidine, and one [ 27 ] used four concentrations of dexmedetomidine. Eight studies [ 3 , 11 , 21 , 23 – 27 ] with Jadad scores ≥4 were regarded as of high-quality.…”

Section: Resultsmentioning

confidence: 99%

“…The risk of bias assessments is presented in Figure 2 . Six RCTs [ 11 , 23 – 27 ] were recorded using a computer or a random number generator for randomization, and three [ 23 , 26 , 27 ] reported allocation concealment via sealed envelopes. A double-blind method was carried out in six studies [ 21 , 23 – 27 ], and the implementation of blinding of outcomes was carried out in five studies [ 21 , 23 , 25 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

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Effect of Epidural Dexmedetomidine as an Adjuvant to Local Anesthetics for Labor Analgesia: A Meta-Analysis of Randomized Controlled Trials

Li

¹

,

Hu

²

,

Li

³

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Background. This study aims to determine the analgesic effect and safety of dexmedetomidine as an adjuvant to epidural local anesthetics during labor. Methods. Randomized controlled trials comparing epidural blocks with or without dexmedetomidine for labor analgesia were comprehensively searched. Review manager 5.4 was used to analyze the extracted data. Results. Compared with placebo and opioids, dexmedetomidine relieved labor pain of 15 min ( P = 0.002 ), 30 min ( P = 0.01 ), and 120 min ( P = 0.02 ) after block and at the moment of fetal disengagement ( P = 0.0002 ), decreased mean arterial pressure of 120 min ( P = 0.01 ), heart rate of 30 min ( P = 0.003 ), 60 min ( P < 0.00001 ), and 120 min ( P < 0.00001 ) after block, blood loss ( P = 0.02 ), and the incidence of nausea/vomiting ( P = 0.006 ), and increased the incidence of maternal bradycardia ( P = 0.04 ). However, sensitivity analysis only found that the incidence of nausea/vomiting was significantly different. Compared with placebo, dexmedetomidine relieved labor pain of 30 min after block ( P < 0.00001 ) and did not increase the incidences of side effects, but only two studies were enrolled. Compared with opioids, dexmedetomidine decreased the incidence of nausea/vomiting ( P = 0.002 ), increased the incidence of maternal bradycardia ( P = 0.04 ), and had a similar effect on labor pain relief; however, sensitivity analysis found that significant difference existed only at the incidence of nausea/vomiting. Other outcomes from meta-analysis or subgroup analysis were not different. Conclusions. Epidural dexmedetomidine has the potential to offer a better analgesic effect than placebo, similar labor pain control to opioids, and has no definite adverse effects on the parturient or fetus, but more high-quality studies are needed to confirm these conclusions.

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“… 4 , 5 In contrast to opioids, dexmedetomidine has been used safely and effectively for epidural labor analgesia without increasing the incidence of adverse effects. 6–12 Consequently, it can be recommended that dexmedetomidine is used as an epidural adjuvant instead of opioids in some clinical circumstances, especially for parturients with opioid intolerance. Previous studies have reported the appropriate doses of epidural dexmedetomidine used for labor analgesia, whereas the optimal dose is unknown.…”

Section: Introductionmentioning

confidence: 99%

Determination of the Dose-Response Relationship of Epidural Dexmedetomidine Combined with Ropivacaine for Labor Analgesia

JX¹,

JL²,

SJ³

et al. 2022

DDDT

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Background The safety and efficacy of dexmedetomidine for epidural labor analgesia have been reported in numerous literatures, but the optimal dose has not been fully determined. The objective of this study was to determine the dose-response relationship of epidural dexmedetomidine (combined with ropivacaine) for labor analgesia. Methods A total of 120 full-term laboring parturients requesting epidural labor analgesia were enrolled in the study from July 5, 2020 to September 22, 2021. The parturients were randomly assigned to receive 0, 0.1, 0.2, 0.3, 0.4 or 0.5 μg/mL dexmedetomidine combined with 0.075% ropivacaine epidurally. An effective dose was defined as numerical rating scale (NRS) pain score ≤3 at 30-minutes of epidural drug injection. The dose-response relationship of dexmedetomidine (with ropivacaine) for epidural labor analgesia was performed using probit regression. The median effective dose (ED 50 ) and the 95% effective dose (ED 95 ) values for epidural dexmedetomidine combined with 0.075% ropivacaine with 95% confidence intervals (CIs) were derived by interpolation. Results The estimated values of ED 50 and ED 95 with 95% CIs for epidural dexmedetomidine (combined with 0.075% ropivacaine) were 0.085 (0.015 to 0.133) μg/mL and 0.357 (0.287 to 0.493) μg/mL, respectively. No differences were found among groups for sensory block level, number of parturients with Bromage score >0, total dosage of analgesics, cesarean delivery rate, fetal birth weight, Apgar score at 1-minute, Apgar score at 5-minutes and adverse effects. Compared with other groups, group dexmedetomidine 0.5 μg/mL had a longer duration of the first stage of labor. Conclusion The ED 50 and ED 95 values of dexmedetomidine for epidural labor analgesia was 0.085 and 0.357 μg/mL under the conditions of this study. Dexmedetomidine is a suitable adjuvant for epidural labor analgesia.

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Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: A randomized controlled trial

Cited by 23 publications

References 38 publications

A Comparison Between Dexmedetomidine and Clonidine as Adjuvants to Levobupivacaine in Labour Analgesia

A Comparison Between Dexmedetomidine and Clonidine as Adjuvants to Levobupivacaine in Labour Analgesia

Effect of Epidural Dexmedetomidine as an Adjuvant to Local Anesthetics for Labor Analgesia: A Meta-Analysis of Randomized Controlled Trials

Determination of the Dose-Response Relationship of Epidural Dexmedetomidine Combined with Ropivacaine for Labor Analgesia

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