Patient-controlled epidural analgesia in labor: The addition of clonidine to bupivacaine-fentanyl

Background and Objectives: Epidural clonidine has not been evaluated as a c omponent of patient-controlled epidural analgesia (PCEA) solutions during l abor. A randomized, double-blind trial was conducted to investigate the eff icacy and side effects of PCEA using bupivacaine and fentanyl, with or with out clonidine. Methods: Seventy-five healthy parturients in active labor we re assigned to a PCEA solution of 0.0625% bupivacaine and fentanyl 2 mu g/m L (4 mt demand bolus, 15 min lockout), with or without clonidine 4.5 mu g/m L. The primary outcome measure was parturient rating of analgesia; others a ssessments included pain scores, drug utilization, supplementation and side effects. Results: Thirty-one parturients received clonidine (group BFC) and 38 recei ved control solution (group BF). Eight (6 group BE 2 group BFC, P = .28) fa iled to achieve satisfactory epidural. analgesia. There was a trend for par turient ratings of pain relief to be higher in group BFC, with significantl y more reporting excellent first-stage analgesia (81% v 57%, P < .05). Pain scores were similar. Clonidine (median dose, 28 mu g/h) reduced total bupi vacaine and fentanyl use (P < .01), and reduced supplementation (P < .01). Maternal blood pressure (BP) and recordings of systolic BP below 100 mm Hg did not differ. Group BFC had higher sedation scares (P < .01), but no one appeared oversedated. Shivering was reduced in group BFC (P < .01). Conclusions: The addition of clonidine to epidural bupivacaine and fentanyl for PCEA in labor improved analgesia, reduced the supplementation rate, an d reduced shivering. Increased sedation and lower BP were not clinically im portant.