Side effects of the addition of clonidine 75 μg or sufentanil 5 μg to 0.2% ropivacaine for labour epidural analgesia

Dewandre, Pierre-Yves; Decurninge, Valérie; Bonhomme, Vincent; Hans, Pol; Brichant, Jean-François

doi:10.1016/j.ijoa.2009.08.003

Cited by 18 publications

(11 citation statements)

References 33 publications

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“…determined that epidural clonidine 75 μg had the same local anaesthetic sparing effect as sufentanil 5 μg when administered as part of ropivacaine‐based epidural analgesia [98]. However, the same group demonstrated that clonidine administered as a bolus resulted in greater maternal hypotension necessitating higher ephedrine and fluid requirements compared with an equipotent dose of sufentanil [99]. The authors concluded that based on these results, this dose of clonidine could not be recommended for labour epidural analgesia.…”

Section: Adjuvantsmentioning

confidence: 99%

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

Loubert¹,

Hinova

Fernando

2011

Anaesthesia

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SummarySeveral strategies and alternative therapies have been used to provide analgesia for labour pain. Over the last few years, a number of improvements have enhanced the efficacy and safety of neuraxial analgesia and ultimately have improved mothers' satisfaction with their birth experience. As labour analgesia is a field of obstetric anaesthesia that is rapidly evolving, this review is an update, from a clinical point of view, of developments over the last 5-7 years. We discuss advantages and controversies related to combined spinal-epidural analgesia, patient controlled epidural analgesia and the integration of computer systems into analgesic modalities. We also review the recent literature on future clinical and research perspectives including ultrasound guided neuraxial block placement, epidural adjuvants and pharmacogenetics. We finally look at the latest work with regards to epidural analgesia and breastfeeding. Several strategies and alternative therapies have been used to provide analgesia for one of women's most painful experiences in life, labour pain. These include non-pharmacological approaches such as hypnosis, acupuncture, hydrotherapy and transcutaneous electrical nerve stimulation as well as the administration of nitrous oxide and low-dose sevoflurane and parenteral opioids. Although some of these therapies provide satisfactory pain relief from the mothers' point of view [1,2], there is evidence that neuraxial local anaesthetics and opioids yield superior and more reliable analgesia than these aforementioned methods [3,4].Although invasive, neuraxial labour analgesia is considered safe practice. Over the last decade, several improvements have enhanced the efficacy and safety of neuraxial analgesia and ultimately have improved mothers' satisfaction with their birth experience. These developments include the introduction of combined spinal-epidural (CSE) analgesia, 'mobile epidurals', patient controlled epidural analgesia (PCEA), computer assisted injection of epidural solutions and ultrasound guided neuraxial techniques. Some of these advances have already been introduced into clinical practice while ongoing research is stimulated by the exciting clinical perspectives brought forward by other developments. This review focuses on the recent advances in neuraxial labour analgesia and on the relevant scientific literature published in the last 5 years. We performed a MEDLINE-based search of all the literature published from January 2005, using the following keywords: labour analgesia; epidural; spinal; combined spinal-epidural; pregnancy; obstetric; neostigmine; clonidine; pharmacogenetics; and breastfeeding. We focussed our research on prospective, randomised controlled trials as well as meta-analysis and further completed our review by including retrospective observational trials and case reports where relevant. For clarity of discussion and when considered necessary, we also included literature from earlier years. Initiating neuraxial analgesiaUltrasound guided neuraxial techniques Ultrasound i...

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Section: Adjuvantsmentioning

confidence: 99%

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

Loubert¹,

Hinova

Fernando

2011

Anaesthesia

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“…in their study,[35] concluded that hypotension occurs more frequently when clonidine is added to epidural ropivacaine instead of an equi analgesic dose of sufentanil. Therefore, clonidine cannot be recommended for routine administration for labour epidural analgesia.…”

Section: Newer Local Anaesthetics and Adjuvants–clonidine And Neostigmentioning

confidence: 99%

Labour analgesia: Recent advances

Pandya

2010

Indian J Anaesth

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Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients. Technological advances like use of ultrasound to localize epidural space in difficult cases minimizes failed epidurals and introduction of novel drug delivery modalities like patient-controlled epidural analgesia (PCEA) pumps and computer-integrated drug delivery pumps have improved the overall maternal satisfaction rate and have enabled us to customize a suitable analgesic regimen for each parturient. Recent randomized controlled trials and Cochrane studies have concluded that the association of epidurals with increased caesarean section and long-term backache remains only a myth. Studies have also shown that the newer, low-dose regimes do not have a statistically significant impact on the duration of labour and breast feeding and also that these reduce the instrumental delivery rates thus improving maternal and foetal safety. Advances in medical technology like use of ultrasound for localizing epidural space have helped the clinicians to minimize the failure rates, and many novel drug delivery modalities like PCEA and computer-integrated PCEA have contributed to the overall maternal satisfaction and safety.

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“…Clonidine, an α 2 ‐agonist, has been used as an adjuvant for labor analgesia . Its administration does not induce motor impairment, produces analgesia through a non‐opioid mechanism and is therefore devoid of adverse effects such as nausea, pruritus or respiratory depression . The benefit of combining neostigmine and clonidine relies on neutralization of hypotension risk, and is associated with improved postoperative analgesia in a number of studies.…”

Section: Introductionmentioning

confidence: 99%

“…10 Its administration does not induce motor impairment, produces analgesia through a non-opioid mechanism and is therefore devoid of adverse effects such as nausea, pruritus or respiratory depression. 11 The benefit of combining neostigmine and clonidine relies on neutralization of hypotension risk, and is associated with improved postoperative analgesia in a number of studies. The spinal route cannot be recommended for routine administration of labor epidural analgesia because it has side-effectsclonidine can produce sedation and hypotension, 12,13 and neostigmine can cause nausea and vomiting 14limiting the clinical usefulness of this route of administration.…”

Section: Introductionmentioning

confidence: 99%

“…The benefit of combining neostigmine and clonidine relies on neutralization of hypotension risk, and is associated with improved postoperative analgesia in a number of studies. The spinal route cannot be recommended for routine administration of labor epidural analgesia because it has side‐effects – clonidine can produce sedation and hypotension, and neostigmine can cause nausea and vomiting – limiting the clinical usefulness of this route of administration. The epidural administration of these drugs seems to cause fewer side‐effects and produces prolonged initial analgesia.…”

Section: Introductionmentioning

confidence: 99%

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Effects of epidural neostigmine and clonidine in labor analgesia: A systematic review and meta‐analysis

Zhang

2014

J of Obstet and Gynaecol

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Side effects of the addition of clonidine 75 μg or sufentanil 5 μg to 0.2% ropivacaine for labour epidural analgesia

Cited by 18 publications

References 33 publications

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

Labour analgesia: Recent advances

Effects of epidural neostigmine and clonidine in labor analgesia: A systematic review and meta‐analysis

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