The use of neuraxial adjuvant drugs (neostigmine, clonidine) in obstetrics

Roelants, Fabienne

doi:10.1097/01.aco.0000192812.56161.f8

Cited by 71 publications

(52 citation statements)

References 26 publications

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“…The lower heart rate decreases the myocardial oxygen demand of the parturient and none of the patients in our study required any type of intervention for decreased heart rate. In spite of the fact that clonidine crosses placenta and can lead to foetal bradycardia as seen in the previous studies using higher doses of clonidine, the dose in our study did not caused bradycardia to the foetus and the incidence of caesarean deliveries were same and comparable in all the three groups [17].…”

Section: Discussioncontrasting

confidence: 81%

“…No other adverse effect was seen in our study. The incidence of hypotension and bradycardia was much lower in our study than previous studies which used higher concentration of drugs [17,22]. The total amount of ropivacaine 0.125% in the three groups were 47.2ml, 41.25ml, and 35ml respectively and the number of PCA bolus required in the three groups were 3.4, 1.9, 1.03 respectively.…”

Section: Discussioncontrasting

confidence: 64%

“…The dose of clonidine used in our study was 1mcg/kg in loading bolus, which approximates to 50-70 mcg clonidine in loading bolus. Previous studies have shown that clonidine used in doses greater than 100 mcg have been associated with maternal and foetal bradycardia, maternal hypotension and adverse foetal outcome while doses less than 30mcg are ineffective in increasing the potency of local anaesthetics [17], but 75 mcg clonidine is effective in labour analgesia when given with local anaesthetics [11], So we used the clonidine in 1 mcg/kg dose as patients in our study were of lesser height and weight as compared to the patients enrolled in above study, thus avoiding overdosing of clonidine in the patients.…”

Section: Discussionmentioning

confidence: 99%

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Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Ahirwar

Prakash

Kushwaha

et al. 2014

JCDR

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Background: Feeling of pain is one of the most important emotional determinants which dominate the perception of females who undergo the process of labour and delivery. Patient controlled epidural labour analgesia (PCEA) is convenient and safer technique for this purpose. Very few studies compared clonidine and fentanyl with ropivacaine in labour analgesia in past. This study was undertaken to compare fentanyl and clonidine in PCEA. Aims:To compare low concentration ropivacaine with or without fentanyl or clonidine for labour analgesia and its effect on maternal and foetal safety. Settings and Design:Prospective, double blind, randomized, comparative study. Materials and Methods:Ninety primegravida in labour were divided into three groups (n=30) and patient controlled epidural labour analgesia was given to them: Initial bolus of 10ml of ropivacaine 0.125% in Group I; with fentanyl 2 µg/ml in Group II and with clonidine 1µg/kg in Group III. Subsequently each group received ropivacaine 0.125% through patient controlled epidural analgesia (PCEA) as background infusion of 5 ml/hr with lockout interval time of 10min and subsequent bolus of 5ml. Hemodynamic parameters, sensory level, motor block and pain relief were noted. Total analgesic dose of local anaesthetic and feto-maternal adverse effects were also recorded.Results: At baseline, groups were matched demographically, hemodynamically as well as for intensity of pain. There was a statistically significant decrease in hemodynamic parameters from baseline in all groups with maximum reduction in group III. A significant difference among groups in VAS was observed at zero min and from 120min till 240min intervals and lowest values were in Group III. No significant difference was observed among the groups for mode of delivery and expulsive efforts. Total analgesic dose and PCA bolus requirement was maximum in Group I and minimum in Group III and the difference was statistically significant among groups. Six (20%) patients had shivering in Group II and hypotension was recorded in only 1 (3.3%) patient of Group III.Conclusion: Ropivacaine 0.125% was effective in decreasing labour pain without any motor blockade. Clonidine 1µg/kg was superior to fentanyl 2µg/ml as an

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Section: Discussioncontrasting

confidence: 81%

Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Ahirwar

Prakash

Kushwaha

et al. 2014

JCDR

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“…A comprehensive labour analgesia program has to include newer procedures and ajuvant drugs to facilitate ambulation, excellent pain relief, patient comfort and safety for the mother-fetus binomial. [62,63,64] Spinal clonidine has been used for labour analgesia, to enhance spinal anaesthesia during cesarean section, and for postoperative pain relief. Its use tends to be more frequent in this field, since it reduces opioids doses, and thus the side effects such as emesis and maternal pruritus, and the possibility of respiratory depression secondary to rostral opioid distribution.…”

Section: Obstetricsmentioning

confidence: 99%

Intrathecal Clonidine as Spinal Anaesthesia Adjuvant — Is there a Magical Dose?

Whizar-Lugo¹,

Flores-Carrillo²,

Ramírez³

2014

Topics in Spinal Anaesthesia

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“…Several trials evaluated the effects of epidural neostigmine (220,221). Neostigmine seems to be promising as an adjuvant drug for labour analgesia.…”

Section: Neostigminementioning

confidence: 99%

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Velde

2009

Revista Española de Anestesiología y Reanimación

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Most authors would agree that central neuraxial analgesia is the best form to manage labor pain. When neuraxial analgesia is administered to the parturient in labor, different management choices must be made by theanesthetist: how will we initiate analgesia, how will analgesia be maintained, which local anesthetic will we use for neuraxial analgesia and which adjuvant drugs will we combine? The present manuscript tries to review the literature to answer these questions. INITIATION OF NEURAXIAL ANALGESIAA lmost two decades have passed since French and American trials evaluated the use of spinal opioids during labor and since European randomized trials compared conventional epidural analgesia with combined spinal epidural (CSE) analgesia (1-3). CSE analgesia has gained worldwide acceptance and is becoming increasingly popular as the method of choice for labor pain relief (4-9). Obstetric anesthetists are divided when questioned on the place of CSE in labor analgesia. Whilst some authors feel it should be the technique of choice, others reserve CSE for certain indications (10-15). Recently, Simmons et al. published a Cochrane review concluding that CSE offers little benefit as compared to conventional epidural analgesia (16). However, the authors of this meta-analysis did acknowledge that CSE produced faster analgesia, resulted in less need for rescue analgesia and was associated with less urinary retention. Apart from a slight increase in the incidence of pruritus, these beneficial effects were not associated with more complications. The three demonstrated benefits of CSE are sufficient to promotes it's use if the side-effect profile remains unaltered. Furthermore it must be stressed that this Cochrane review can be criticized. Firstly, a number of well performed studies were excluded from analysis because of uncertain reasons. Inclusion of these well performed studies into the analysis might have affected the overall conclusions. Secondly, a number of outcomes were not considered in the analysis such as one-sided analgesia, epidural catheter reliability, anesthetist intervention rate, local anesthetic consumption and the occurrence of fetal heart abnormalities. Finally, very different types of CSE were used in the various studies. They were all considered to be a generic procedure and analyzed combined.Arguably the most obvious advantage of the CSE technique is the rapid and spectacular onset of effective analgesia with minute concentrations of local anesthetics with or without adjuvant drugs (16). Consistently, effective labor analgesia is accomplished within 4-6 minutes

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The use of neuraxial adjuvant drugs (neostigmine, clonidine) in obstetrics

Abstract: Co-administration of neuraxial drugs may enhance analgesia and reduce the side effects of each drug. Clonidine and neostigmine may be used in obstetrics, under some conditions.

Cited by 71 publications

References 26 publications

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Intrathecal Clonidine as Spinal Anaesthesia Adjuvant — Is there a Magical Dose?

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

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