Comparison of Postoperative Analgesic Effect of Intrathecal Clonidine and Fentanyl Added to Bupivacaine in Patients Undergoing Cesarean Section: A Prospective Randomized Double-Blind Study

Abstract

Objectives. To compare the analgesic efficacy of intrathecal clonidine and fentanyl added to bupivacaine after cesarean section. Methods. Ninety patients scheduled for cesarean section under spinal anesthesia were randomly allocated to one of the three following groups to receive bupivacaine 10 mg combined with 75 µg clonidine (group C), bupivacaine 10 mg combined with 0.5 mL fentanyl (group F), and bupivacaine 10 mg combined with 0.5 mL distilled water (group P), intrathecally. The time to first analgesic request, analgesic requirement in the first 24 hours after surgery, sensory and motor blockade onset time, duration of sensory and motor blockade, the incidence of hypotension, ephedrine requirements, bradycardia, and hypoxemia were recorded. Results. The duration of anesthesia in clonidine group (275.10 ± 96.09) was longer compared to the placebo (211.73 ± 74.80) and fentanyl (192.33 ± 30.36) groups. This difference between group C versus F (P = 0.006) and P groups (P < 0.001) was significant. Similarly, the mean time to first analgesic request was also longer in group C (519.44 ± 86.25) than in groups F (277.88 ± 94.25) and P (235.43 ± 22.35 min). This difference between group C versus F (P < 0.001) and P groups (P < 0.001) was significant. Conclusion. Intrathecal clonidine 75 µg with bupivacaine prolonged the time to first analgesic request compared to fentanyl; however, the total analgesic consumption within the first 24 h postoperative was similar in fentanyl and clonidine groups following cesarean section. This trial is registered with ACTRN12611000909921 and ClinicalTrials.gov NCT01425658.

A comparative study of hemodynamic changes and adverse effects of intrathecal bupivacaine with fentanyl and intrathecal bupivacaine with clonidine in infra-umbilical abdominal and lower limb surgery

“…Few studies have reported high incidence of pruritus in fentanyl group compared to clonidine group. 25,40…”

Anesthetic management for cesarean section in a patient receiving transplacental treatment of fetal tachyarrhythmia: a case report

“…We were also concerned about the potential maternal bradycardia associated with the use of intrathecal opioids, such as morphine [16]. We elected to use fentanyl, which was not associated with maternal bradycardia in a previous report [17]. The mother did not complain of any pain during the surgery.…”

Randomized study of postcesarean analgesia with intrathecal morphine alone or combined with clonidine

“…In addition, the use of neuraxial opioids has been related to side effects varying in incidence and intensity, according to the dose level [2,3,35,37]. Related to intrathecal opioids, it is essential to find alternatives to improve analgesia and to reduce side effects; 1 option is the combination of local anesthetics with opioids and clonidine because these drugs have synergistic effects [8,[16][17][18][19][20][21][22][23][24][25][26][27]31]. However, based on our data, the addition of clonidine to morphine does not result in better analgesia than the use of morphine alone, in contrast with the Paech study, which showed 240 parturients divided into 6 groups that were intrathecally administered 150 μg clonidine, 100 μg morphine, or 100 μg morphine with 30, 60, 90, or 150 μg clonidine.…”

“…Clonidine is an α 2 -adrenoceptor agonist that can be used as an adjuvant to other analgesics to improve postoperative analgesia [8,[16][17][18][19][20][21][22][23][24][25][26][27]. When administered intrathecally, clonidine results in analgesia by reducing the release of substance P, modulating N-methyl-D-aspartate receptors, increasing acetylcholine concentrations in the cerebrospinal fluid, and increasing the production of nitric oxide [16,19,20,[28][29][30][31].…”