INTRATHECAL CLONIDINE AND FENTANYL WITH HYPERBARIC BUPIVACAINE IMPROVES ANALGESIA DURING CESAREAN-SECTION

Seventy-eight pregnant women at term, scheduled for elective cesarean section, were enrolled in this multicenter trial to compare the analge sic efficacy and side effect profile of a spinal block with hyperbaric bupivacaine alone (Group B) or combined with 75 mu g of clonidine (Gr oup BC) or with clonidine 75 mu g and fentanyl 12.5 mu g (Group BCF). Intraoperatively, clonidine increased the spread of the sensory block and decreased pain (pain scores 23 +/- 7 mm vs 17 +/- 6 and 2 +/- 1 mm for Group B versus Groups BC and BCF; P < 0.05) and analgesic supplem entation. This improved analgesia was best with the clonidine-fentanyl combination (Group BC versus Group BCF; P < 0.05). Postoperative anal gesia was prolonged only in Group BCF (215 +/- 79 min vs 137 +/- 35 an d 183 +/- 80 min for Group BCF versus Groups B and BC; P < 0.05). Bloo d pressure and heart rate changes were not significantly different amo ng groups, whereas sedation and pruritus were significantly more frequ ent in Group BCF. Nausea and vomiting were decreased in Groups BC and BCF. Apgar scores and umbilical artery blood pH were not different amo ng groups. We conclude that adding a small dose of intrathecal clonidi ne to bupivacaine increases the quality of intraoperative analgesia an d decreases pain during cesarean section. Combining clonidine with fen tanyl further improved analgesia. Implications: Ln this study, we demo nstrate improved intraoperative spinal analgesia by adding 75 mu g of clonidine to bupivacaine; side effects were not increased. The combina tion of clonidine and fentanyl further improved analgesia but moderate ly increased sedation and pruritus.