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OBSTETRIC ANESTHESIA

A Randomized, Double-Blinded Trial of Subarachnoid Bupivacaine and Fentanyl, With or Without Clonidine, for Combined Spinal/Epidural Analgesia During Labor

Michael J. Paech, FANZCA^*, Samantha L. Banks, FRCA^*, Lyle C. Gurrin, PhD, Seng T. Yeo, FRCA^*, and Timothy J. G. Pavy, FANZCA^*

*Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Subiaco, Western Australia; and the Women and Infants Research Foundation, Perth, Western Australia

Address correspondence and reprint requests to Michael J. Paech, FANZCA, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, 374 Bagot Rd., Subiaco 6008 WA, Australia. Address e-mail to michael.paech{at}health.wa.gov.au

Subarachnoid clonidine may increase the duration of spinal opioid and local anesthetic analgesia during labor, but it may also increase hypotension and sedation, and the therapeutic range is unclear. We studied 110 term parturients of mixed parity having combined spinal/epidural analgesia during labor in this randomized, double-blinded trial. All received subarachnoid fentanyl 20 µg and bupivacaine 2.5 mg, plus either saline or clonidine (15, 30, or 45 µg). Of 101 per-protocol parturients (n = 25, 24, 26, and 26 in Groups C0, C15, C30, and C45, respectively), 22 delivered before the cessation of spinal analgesia. Group demographics and pain scores from Time 0 to 120 min were similar. There was no significant difference among groups in the duration of spinal analgesia (P = 0.09) or in the duration of clonidine groups combined compared with control (median, 120 min [interquartile range, 96–139 min] versus 98 min [80–120 min]; P = 0.07). Systolic blood pressure was significantly lower in all clonidine groups between 40 and 90 min (P = 0.001). Hypotension (P = 0.05) and the requirement for ephedrine (P = 0.02) were dose dependent, but groups had a similar incidence of hypotension. The addition of clonidine 15–45 µg to subarachnoid fentanyl and bupivacaine reduced blood pressure and did not significantly increase the duration of spinal analgesia.

IMPLICATIONS: The addition of 15–45 µg of clonidine to subarachnoid fentanyl plus bupivacaine did not significantly increase the duration of spinal analgesia but did decrease maternal blood pressure. The results of this study do not support the use of subarachnoid clonidine to prolong the action of spinal labor analgesia when fentanyl plus bupivacaine are administered.

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