DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20173988

Comparative study between levobupivacaine with clonidine and levobupivacaine with fentanyl in epidural labour analgesia in rural set up

Prashant K. Mishra, Anand K. Singh, Pragati Divedi

Abstract


Background: Neuraxial techniques are the gold standard for intrapartum labour analgesia. Neuraxial labour analgesia using new local anaesthetics such as levobupivacaine has become very popular by virtue of the safety and lesser motor blockade caused by these agents. Multiple randomized controlled trials comparing epidural analgesia with systemic opioids, nitrous oxide or both have demonstrated lower internal pain scores and higher maternal satisfaction with neuraxial analgesia. The purpose of this study is to compare fentanyl and clonidine combination with levobupivacaine in terms of effect of epidural labour analgesia on fetal outcome and incidence of instrumental or caesarean delivery and duration of second stage of labour.

Methods: A total of 50 primiparous with singleton pregnancy and vertex presentation and cervical dilatation of 3-5 cm were enrolled for the study in our hospital in department of obstetrics and gynecology. They were divided into group 1 and group 2 (25 patients in each group). Group 1 received 10 ml. of 0.125% isobaric levobupivacaine with 25µg fentanyl and group 2 received 10 ml of 0.125% isobaric levobupivacaine with 60 µg clonidine. Parturients were given epidural analgesia on numerical rating scale (NRS) Score >3. Breakthrough pain supplemented with 3-5 ml of 0.125% levobupivacaine. Data collected were demographic profile of the patients, analgesic qualities, 1st and 2nd stage labour duration, side effects and feto-maternal outcome.

Results: Post treatment mean NRS were almost similar between two groups at all periods except at 15 minutes when it was significantly lower for group 2 (2.64±0.49). Onset of analgesia was earlier in group 2 (13.68±0.94) in comparison to group 1 (15.36±1.18) and was statistically significant.

Conclusions: In conclusion Group 2 (levobupivacaine with clonidine) showed significant difference in early onset of analgesia but did not show any significant difference in duration of labour, maternal and fetal outcome and mode of delivery.


Keywords


Clonidine, Epidural labour analgesia, Fentanyl, Levobupivacaine

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References


Shnider SM, Abboud T, Artal R, Henriksen EH, Stefani SJ, Levinson G. Maternal catecholamines decrease during labour after lumber epidural analgesia. Am J Obstet Gynecol. 1983;147:13-5.

Dowswell T, Bedwell C, Lavender T. Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. Cochrane Database Systematic Reviews. 2009;15(2):CD007214.

Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain management in labour. Cochrane Database Systematic Reviews. 2006;18(4):CD003521.

Dickinson JE, Paech MJ, McDonald SJ, Evans SF. Maternal satisfaction with childbirth and intrapartum analgesia in nulliparous labour. Australian New Zealand J Obstetr Gynecol. 2003;43:463-8.

Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Systematic Reviews. 2005;19(4):CD000331.

Ramin SM, Gambling DR, Lucas MJ, Sharma SK, Sidawi JE, Leveno KJ. Randomized trial of epidural versus intravenous analgesia during labour. Obstet Gynecol. 1995;86:783-9.

Jouppila R, Hollmen A. The effect of segmental epidural analgesia on maternal and foetal acid-base balance, lactate, serum potassium and creatine phosphokinase during labour. Acta Anaesth Scand. 1976;20:259-68.

Lederman RP, Lederman E, Work B, McCann DS. Anxiety and epinephrine in multiparous labour: relationship to duration of labour and fetal heart rate pattern. Am J Obstet Gynecol. 1985;153:870-7.

Levinson G, Shinder SM, de Lorimier AA, Steffenson JL. Effects of maternal hyperventilation on uterine blood flow and fetal oxygenation and acid-base status. Anaesthesiol. 1974;40:340-7.

Sanford M, Keating GM: Levobupivacaine: a review of its use in regional anaesthesia and pain management. Drugs. 2010;70(6):761-91.

Cox CR, Faccenda KA, Gilhooly C, Bannister J, Scott NB, Morrison LM. Extradural S (-) bupivacaine: comparison with racemic RS-bupivacaine. Br J Anaesth. 1998;80(3):289-93.

Kopacz DJ, Allen HW, Thompson GE. A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth Analg. 2000;90(3):642-8.

Huang YF, Pryor ME, Mather LE, Veering BT. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth Analg. 1998;86(4):797-804.

Loper KA, Ready LB, Downey M, Sandler AN, Nessly M, Rapp S. Epidural and intravenous fentanyl infusions are clinically equivalent after knee surgery. Anesth Analg. 1990;70(1):72-5.

Cigarini I, Kaba A, Bonnet F, Brohon E, Dutz F, Damas F, et al. Epidural clonidine combined with bupivacaine for analgesia in labour: effects on mother and neonate. Reg Anesth. 1995;20:113-20.

Claes B, Soetens M, Van Zundert A, Datta S. Clonidine added to bupivacaine-epinephrine- sufentanil improves epidural analgesia during child birth. Reg Anesth Pain Med. 1998;23:540-7.

Eisenach JC, Castro MI, Dewan DM, Rose JC. Epidural clonidine analgesia in obstetrics: sheep studies. Anesthesiol. 1989;70:51-6.

Le Polain B, De Kock M, Scholtes JL, Van Lierde M. Clonidine combined with sufentanil and bupivacaine with adrenaline for obstetric analgesia. Br J Anaesth. 1993;71:657-60.

Olofsson C, Ekblom A, Ekman-Ordeberg G, Irestedt L. Obstetric outcome following epidural analgesia with bupivacaine-adrenaline 0.25% or bupivacaine 0.125% with sufentanil: a prospective randomized controlled study in 1000 parturients. Acta Anaesthesiol Scand. 1998;42:284-92.

Murphy JD, Henderson K, Bowden MI, Lewis M, Cooper G M. Bupivacaine versus bupivacaine plus fentanyl for epidural analgesia: effect on maternal satisfaction. BMJ. 1991;302:564-7.

Buggy DJ, MacDowell C. Extradural analgesia with clonidine and fentanyl compared with 0.25% bupivacaine in the first stage of labour. Br J Anaesth. 1996;76:319-21.

Chassard D, Mathon L, Dailler F, Golfier F, Tournadre JP, Bouletreau P. Extradural clonidine combined with sufentanil and 0.0625% bupivacaine for analgesia in labour. Br J Anaesth. 1996;77:458-62.

Cohen SE, Tan S, Albright GA, Halpern J. Epidural fentanyl/bupivacaine mixtures for obstetric analgesia. Anaesthesiol. 1987;67:403-7.

Chhetty YK, Naithani U, Gupta S, Bedi V, Agrawal I, Swain L. Epidural labour analgesia: a comparison of ropivacaine 0.125% versus 0.2% with fentanyl. J Obstet Anaesth Critcare. 2013;3:16-22.

Syal K, Dogra R, Ohri A, Chauhan G, Goel A. Epidural labour analgesia using bupivacaine and clonidine. J Anaesthesiol Clin Pharmacol. 2011;27(1):87-90.

Sah N, Vallejo M, Phelps A, Finegold H, Mandell G, Ramanathan S. Efficacy of ropivacaine, bupivacaine and levobupivacaine for labour epidural analgesia. J Clin Anesthesia. 2007;19(3):214-7.

Fettes PD, Moore CS, Whiteside JB, McLeod GA, Wildsmith JA. Intermittent versus continuous administration of epidural ropivacaine with fentanyl for analgesia during labour. Br J Anaesth. 2006;97:359-64.

Singh S, Singh A, Srivastava U. Low dose epidural analgesia during labour: comparison between patient controlled epidural analgesia with basal continuous infusion and intermittent bolus technique. J Obstet Gynecol India. 2011;61(4):404-7.