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OBSTETRIC ANESTHESIA

The Dose-Sparing Effect of Clonidine Added to Ropivacaine for Labor Epidural Analgesia

Ruth Landau, MD^*, Eduardo Schiffer, MD^*, Michel Morales, MD, Georges Savoldelli, MD^*, and Christian Kern, MD^*

*Division d’Anesthésiologie, Département d’Anesthésiologie, Pharmacologie et Soins Intensifs de Chirurgie (APSIC), and Clinique d’Obstétrique, Département de Gynécologie et Obstétrique, Hôpitaux Universitaires de Genève (HUG), Genève, Suisse

Address correspondence and reprint requests to Ruth Landau, MD, Division d’Anesthésiologie, APSIC, Hôpitaux Universitaires de Genève (HUG), Rue Micheli-du-Crest 12, 1211 Genève 14, Switzerland. Address e-mail to ruth.landau{at}hcuge.ch

To determine the effects of clonidine with ropivacaine during epidural labor analgesia, we studied 66 nulliparous women in early active labor. Women were randomized to receive ropivacaine 0.1% 8 mL plus 75 µg of clonidine (Group 1), ropivacaine 0.2% 8 mL plus 0.5 mL of NaCl 0.9% (Group 2), or ropivacaine 0.2% 8 mL plus 75 µg of clonidine (Group 3) 5 min after a bupivacaine 7.5 mg with epinephrine 15 µg test dose. Upon request, additional analgesia with ropivacaine 0.1% 8 mL followed by ropivacaine 0.2% 8 mL/h was administered. With clonidine, duration of analgesia was increased (132 ± 48 min [Group 1] and 154 ± 42 min [Group 3] versus 91 ± 44 min [Group 2]; P < 0.05), and total ropivacaine dose over the first 4 h was significantly reduced (40.5 ± 15 mg [Group 1] and 47.0 ± 16 mg [Group 3] versus 72.5 ± 18 mg [Group 2]; P < 0.01). The incidence of more profound motor block was more frequent in Group 2 (P < 0.05). Although there was a trend for more women receiving clonidine to require ephedrine for treatment of hypotension, this did not seem to have an impact on fetal outcome or incidence of cesarean deliveries for nonreassuring fetal heart rate tracings. This study demonstrates the dose-sparing effect of clonidine when added to ropivacaine.

IMPLICATIONS: The effect of adding 75 µg of clonidine to ropivacaine for epidural labor analgesia was studied. Clonidine increased analgesia duration and produced dose sparing compared with ropivacaine alone. Despite a tendency for hypotension in women receiving clonidine, there was no apparent effect on delivery mode or neonatal outcome.

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