INTRATHECAL CLONIDINE COMBINED WITH SUFENTANIL FOR LABOR ANALGESIA

Background: Intrathecal sufentanil provides rapid-onset and complete a nalgesia for the first stage of labor, The dose required to produce th is effect can be associated with maternal respiratory depression, hypo tension, nausea, or pruritus. Because clonidine potentiates the analge sic effects of opioids without increasing their side effects, the auth ors wanted to determine the efficacy of low doses of intrathecal cloni dine (15 and 30 mu g) combined with sufentanil. Methods: Ninety-eight parturient requesting labor analgesia were studied. In a combined spin al-epidural technique, patients mere randomly assigned to receive one of the following intrathecal solutions: either 15 mu g clonidine (n = 10); 30 mu g clonidine (n = 10); 2.5 mu g sufentanil (n = 13); 5 mu g sufentanil (n = 13); 2.5 mu g sufentanil and 15 mu g clonidine (n = 13 ); 2.5 mu g sufentanil and 30 mu g clonidine (n = 13); 5 mu g sufentan il and 15 mu g clonidine (n = 13); or 5 mu g sufentanil and 30 mu g cl onidine (n = 13). Visual analog scores for pain, blood pressure, heart rate, sensory levels, incidence of nausea and pruritus, and motor blo ckade, and maternal and cord blood concentrations of clonidine were re corded. Results: patients receiving 30 mu g intrathecal clonidine with 2.5 or 5 mu g intrathecal sufentanil had significantly longer-lasting analgesia (145 +/- 36 and 145 +/- 43 min vs. 104 +/- 35 for those rec eiving 5 mu g intrathecal sufentanil alone). Clonidine levels were und etectable in maternal serum. Conclusions: Thirty micrograms of intrath ecal clonidine combined with 2.5 or 5 mu g intrathecal sufentanil sign ificantly increased the duration of analgesia during the first stage o f labor without adverse maternal or fetal effects.