Epidural labour analgesia using bupivacaine and clonidine

Syal, Kartik; Dogra, RK; Ohri, Anil; Chauhan, Gian; Goel, Ashok K.

doi:10.4103/0970-9185.76658

Cited by 13 publications

(3 citation statements)

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“…We observed that patients who received ropivacaine with clonidine had faster onset of analgesia, longer duration of block, less number of top ups compared to those with ropivacaine without clonidine. Similar results were reported by Ahirwar et al 16 and Landav et al 5 and Syal et al 7 reported reduction in onset of analgesia which was observed in our study also.…”

Section: Discussionsupporting

confidence: 93%

“…Clonidine as adjuvant 5,6 improves the quality of anaesthesia, reducing the dose of local anaesthetic with better hemodynamic stability, not compromising the fetus or maternal outcome. Clonidine is recommended for routine use in labour analgesia 7 with out adverse neonatal outcome. Our study was designed to compare the effect of clonidine as an adjunct with ropivacaine along with ropivacaine only in providing safe and effective labour analgesia and neonatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Comparision of ropivacaine 0.2% with or without clonidine in epidural labor analgesia: A randomised controlled study

Karthik¹,

Kanchanamala

Keerthana³

et al. 2022

SAJHP

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Epidural labour analgesia is considered as the gold standard of pain relief for paturients inspite of the hesitancy that is prevalent in our country in providing pain-free labour. There are several other pharmacological and non pharmacological methods available for providing labour analgesia. Local anaesthetic is an indispensable drug for administering epidural labour analgesia Ropivacaine is the most widely used local anaesthetic for labour analgesia because of its safety profile proven by various studies.It is less potent and onset of action is slightly prolonged when compared to bupivacaine or levobupivacaine. Use of adjuvants along with local anaesthetic reduces the total dose of local anaesthetic that is required for providing effective labour analgesia. Clonidine is a centrally acting partial alpha 2 adrenergic agonist that reduces the anaesthetic and analgesic requirement of local anaesthetic. This study is aimed to study the effect of ropivacaine with clonidine as an adjuvant for labour analgesia.To compare the time of onset of analgesia, total dose of local anaesthetic required, total duration of analgesia and neonatal outcome between the two groups, Group I with ropivacaine and Group II ropivacaine with clonidine.: A prospective randomised controlled study was conducted in a government peripheral medical College after getting ethical committee clearance 100 patrurients randomised into two groups, Group I received 2% ropivacaine and Group II received 2% ropivacaine with 40 micrograms of clonidine.: The results were analysed with SPSSVersion 13 using student t - test and chi square test The mean age was 23.4 ±1.7 years. The mean onset time of Group A and Group B were 12.9±1.3 minutes and 17.7±1.3 minutes with p<0.001 which was significant. Total mean dose of Ropivacaine for both groups were 44.0±8.8 and 54.0±8.9 respectively with P <0.05. Neonatal outcome as measured using APGAR score were 8.5±0.5 and 8.4±0.5 being statistically insignificant.Addition of 40 micrograms of clonidine with Ropivacaine epidurally resulted in rapid onset of analgesia with required dose of Ropivacaine. Use of Clonidine as adjuvant didn't produce any undesirable motor blockade or neonatal depression.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Comparision of ropivacaine 0.2% with or without clonidine in epidural labor analgesia: A randomised controlled study

Karthik¹,

Kanchanamala

Keerthana³

et al. 2022

SAJHP

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“… 16 , 17 In opioid-naïve patients (both non-obstetric and obstetric) epidural clonidine has been shown to decrease post-operative analgesic requirements, prolong the duration of analgesia and have a dose sparing effect on local anesthetic. 23 A 75 patient randomized control trial by Paech et al examined the addition of clonidine 4.5 µg/mL to epidural medication solution of 0.0625% bupivacaine and fentanyl 2 µg/mL, and found that the clonidine group had less total bupivacaine and fentanyl use as well as fewer supplemental doses, but had higher sedation scores. 24 Previous meta analyses have examined clonidine as an analgesic adjunct for cesarean delivery and found that clonidine prolonged motor and sensory blockade and decreased 24-hour opioid consumption.…”

Section: Discussionmentioning

confidence: 99%

Analgesic Outcomes in Opioid Use Disorder Patients Receiving Spinal Anesthesia with or without Intrathecal Clonidine for Cesarean Delivery: A Retrospective Investigation

Cook¹,

Kushelev²,

Coffman³

et al. 2022

JPR

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Background Intrathecal (IT) clonidine has been observed to reduce 24-hour opioid requirements and time to first analgesic request after cesarean delivery, but has not been specifically studied in patients with opioid use disorder (OUD). Methods Patients with OUD undergoing cesarean delivery under spinal or combined spinal-epidural (CSE) anesthesia at our institution from 2011 to 2020 were identified, and only patients with OUD were included in this study. Subjects that received IT clonidine were compared to a control group that did not receive IT clonidine to observe potential differences in analgesic outcomes (24-hour opioid requirements, pain scores and time to first post-operative pain medication) or side-effects (hypotension, vasopressor dosing and bradycardia). Results A total of 160 patients were included (clonidine n = 22, controls n = 138). For the clonidine group, the median IT clonidine dose was 30µg. Clonidine group patients were observed to have greater dose of IT bupivacaine (12 vs 12.75mg; p = 0.01) and IT morphine (100 vs 200µg; p < 0.001). The clonidine group was also observed to have greater incidence of intraoperative hypotension (20% vs 45%; p = 0.01) and maximum phenylephrine dose (50 vs 57.5 µg/min; p < 0.001). The time to first analgesic request (minutes) after surgery was significantly longer for the clonidine group (153.5 vs 207 min; p < 0.001). The average oral oxycodone equivalents taken per 24 hours of hospital admission were significantly less in the clonidine group (82.36 vs 41.67mg; p < 0.001), and the clonidine group also had significantly less oxycodone equivalents taken for each post-operative day. Conclusion IT clonidine was observed to result in reduced 24-hour opioid consumption in patients with OUD and may be useful as part of a multimodal analgesic regimen. The incidence of hypotension and vasopressor doses were greater in patients receiving IT clonidine, and this should be anticipated if IT clonidine is being administered.

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Use of epidural clonidine for the management of analgesia in the opioid addicted parturient on buprenorphine maintenance therapy: an observational study

Hoyt

Shah

Cooley

et al. 2018

International Journal of Obstetric Anesthesia

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Epidural labour analgesia using bupivacaine and clonidine

Cited by 13 publications

References 0 publications

Comparision of ropivacaine 0.2% with or without clonidine in epidural labor analgesia: A randomised controlled study

Comparision of ropivacaine 0.2% with or without clonidine in epidural labor analgesia: A randomised controlled study

Analgesic Outcomes in Opioid Use Disorder Patients Receiving Spinal Anesthesia with or without Intrathecal Clonidine for Cesarean Delivery: A Retrospective Investigation

Use of epidural clonidine for the management of analgesia in the opioid addicted parturient on buprenorphine maintenance therapy: an observational study

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