Epidural Clonidine Analgesia in Obstetrics

Eisenach, James C.; Castro, Martha; Dewan, David M.; Rose, J. C.

doi:10.1097/00132582-198910000-00027

Cited by 4 publications

(6 citation statements)

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“…Furthermore, epidural administration of clonidine, a prototype α -2 agonist, allows a subsequent local anaesthetic-sparing effect throughout the course of labour [3,4]. Clonidine has been recommended as an analgesic in obstetrics [5]. However, epidural or spinal use of clonidine remains subject to caution because of dose-related side effects in the mother (sedation and hypotension), foetal well-being and bradycardia [6,7].…”

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Effects of Subchronic versus Acute in utero Exposure to Dexmedetomidine on Foetal Developments in Rats

Tariq

Černý

Elfaki

et al. 2008

Basic Clin Pharma Tox

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Dexmedetomidine is a highly selective and specific α -2 adrenergic agonist with sedative, analgesic and sympathetic activities. This study was undertaken to investigate the effects of in utero exposure of dexmedetomidine on foetal development and postnatal behaviour in the offspring. Pregnant Sprague-Dawley rats were chronically treated with dexmedetomidine (0, 5, 10 and 20 µ g/kg, subcutaneously) daily from gestation day 7 to day 19. Another group of animals received only a single acute dose of dexmedetomidine (20 µ g/kg) on gestational day 19 to mimic a model for systemic analgesia during labour. Administration of dexmedetomidine did not affect the frequency of implantations. Chronic administration of 10 and 20 µ g/kg of dexmedetomidine significantly reduced the body weight and crown-rump length of pups, whereas a single acute dose (20 µ g/kg) did not affect these parameters. None of the pups exhibited any external malformations or skeletal abnormalities irrespective of treatment assigned. All the pups showed a normal postnatal weight gain during the developmental phase. No significant differences were observed among any of the groups with respect to behavioural performances of offspring in beam balance, grip strength and inclined plane tests as well as motor activity. In conclusion, acute exposure to dexmedetomidine at the anticipated delivery time does not exert any adverse effects on perinatal morphology of pups, their birth weight, crown-rump length, physical growth and postnatal behavioural performances. Since this study was conducted in rats, its clinical relevance in human beings remains to be unclear and warrants further studies.

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confidence: 99%

Effects of Subchronic versus Acute in utero Exposure to Dexmedetomidine on Foetal Developments in Rats

Tariq

Černý

Elfaki

et al. 2008

Basic Clin Pharma Tox

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“…Alguns autores relatam que a clonidina não altera o ritmo cardíaco (TOUSSAINT et al, 1984), enquanto outros sugerem que esse fármaco reduz a velocidade de condução do estímulo elétrico cardíaco (CLEMENTY et al, 1986). Dessa forma, a clonidina deve ser evitada em animais portadores de cardiopatias, pois, em pacientes predispostos, esse fármaco pode desencadear arritmias (EISENACH et al, 1989). Por outro lado, os animais tratados com lidocaína isolada, apesar de também não terem apresentado arritmias, mantiveram a FC dentro da normalidade para a espécie, resultados que concordam com estudos prévios realizados no cão (GASPARINI et al, 2007;CASSU et al, 2010).…”

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“…A inibição da vasodilatação permite a redução na velocidade de captação vascular da lidocaína, de modo a prolongar o bloqueio anestésico (SEGURA et al, 2000). Porém, deve-se ressaltar que a clonidina apresenta alta lipossolubilidade, propriedade molecular que favorece a rápida transferência do fármaco através das meninges para o líquido cefalorraquidiano, determinando curto período de latência e de ação (EISENACH et al, 1989). Todavia, apesar de o tempo anestésico não ter sido prolongado pela clonidina, a maior dispersão cranial do bloqueio foi confirmada neste estudo, de modo que, em 50% dos animais, o bloqueio atingiu até a primeira vértebra lombar, enquanto o uso isolado da lidocaína permitiu bloqueio máximo até a quarta vértebra lombar, resultados que concordam com relatos anteriores (GASPARINI et al, 2007;CASSU et al, 2010).…”

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Anestesia peridural com lidocaína isolada ou associada à clonidina: efeito cardiorrespiratório e analgésico em cães

et al. 2010

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“…13,14 Clonidine is an α2 adrenergic agonist that produces analgesia via a nonopioid mechanism and the combination of epidural bupivacaine with clonidine for labour analgesia has been previously studied. [15][16][17][18] Lipophilic opioids like fentanyl and sufentanil can cause some side effects like sedation, pruritus, lower APGAR score and shivering.…”

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confidence: 99%

Comparative study between levobupivacaine with clonidine and levobupivacaine with fentanyl in epidural labour analgesia in rural set up

Mishra¹,

Singh²,

Divedi³

2017

Int J Res Med Sci

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Background: Neuraxial techniques are the gold standard for intrapartum labour analgesia. Neuraxial labour analgesia using new local anaesthetics such as levobupivacaine has become very popular by virtue of the safety and lesser motor blockade caused by these agents. Multiple randomized controlled trials comparing epidural analgesia with systemic opioids, nitrous oxide or both have demonstrated lower internal pain scores and higher maternal satisfaction with neuraxial analgesia. The purpose of this study is to compare fentanyl and clonidine combination with levobupivacaine in terms of effect of epidural labour analgesia on fetal outcome and incidence of instrumental or caesarean delivery and duration of second stage of labour.Methods: A total of 50 primiparous with singleton pregnancy and vertex presentation and cervical dilatation of 3-5 cm were enrolled for the study in our hospital in department of obstetrics and gynecology. They were divided into group 1 and group 2 (25 patients in each group). Group 1 received 10 ml. of 0.125% isobaric levobupivacaine with 25µg fentanyl and group 2 received 10 ml of 0.125% isobaric levobupivacaine with 60 µg clonidine. Parturients were given epidural analgesia on numerical rating scale (NRS) Score >3. Breakthrough pain supplemented with 3-5 ml of 0.125% levobupivacaine. Data collected were demographic profile of the patients, analgesic qualities, 1st and 2nd stage labour duration, side effects and feto-maternal outcome.Results: Post treatment mean NRS were almost similar between two groups at all periods except at 15 minutes when it was significantly lower for group 2 (2.64±0.49). Onset of analgesia was earlier in group 2 (13.68±0.94) in comparison to group 1 (15.36±1.18) and was statistically significant.Conclusions: In conclusion Group 2 (levobupivacaine with clonidine) showed significant difference in early onset of analgesia but did not show any significant difference in duration of labour, maternal and fetal outcome and mode of delivery.

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Epidural Clonidine Analgesia in Obstetrics

Cited by 4 publications

References 0 publications

Effects of Subchronic versus Acute in utero Exposure to Dexmedetomidine on Foetal Developments in Rats

Effects of Subchronic versus Acute in utero Exposure to Dexmedetomidine on Foetal Developments in Rats

Anestesia peridural com lidocaína isolada ou associada à clonidina: efeito cardiorrespiratório e analgésico em cães

Comparative study between levobupivacaine with clonidine and levobupivacaine with fentanyl in epidural labour analgesia in rural set up

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