B. Lepolain et al., CLONIDINE COMBINED WITH SUFENTANIL AND BUPIVACAINE WITH ADRENALINE FOR OBSTETRIC ANALGESIA, British Journal of Anaesthesia, 71(5), 1993, pp. 657-660
Clonidine produces analgesia via a non-opioid mechanism and it may be
used as an interesting adjuvant to local anaesthetics and opioids in o
bstetric analgesia. To examine the effects of the addition of clonidin
e to bolus injections of bupivacaine, adrenaline and sufentanil, we en
rolled 50 women receiving extradural analgesia for vaginal delivery in
to a double-blind study. They were allocated randomly to two groups: g
roup A received a 10-ml extradural solution of bupivacaine 12.5 mg com
bined with adrenaline 25 mug and sufentanil 10 mug; group B received t
he same solution with clonidine 30 mug. Each patient was allowed two s
ubsequent injections of the chosen solution. Subsequently, if still in
the first stage of labour, analgesia was augmented with additional 10
-ml injections of bupivacaine 12.5 mg with adrenaline 25 mug, without
sufentanil or clonidine. The latter solution was used for perineal ana
lgesia in group A; clonidine 30 mug was added in group B. During the f
irst and second stages of labour, there was no difference between the
two groups in duration of analgesia after the first injection (142 min
in group A; 127 min in group B), number of injections (1.8 in group A
; 1.9 in group B) and the total bupivacaine requirements (33.9 mg in g
roup A; 34 mg in group B). The quality of analgesia was evaluated as v
ery good in both groups. (23/25 in group A; 24/25 in group B). The deg
ree of motor block or the frequency of other side effects were not enh
anced by clonidine. Analgesia was greater for episiotomy in group B (1
5/20 in group A; 21/21 in group B) (P < 0.05). Within the limits of th
is study, the total dose of extradural clonidine 90 mug appeared to be
safe for the mother and the child.