Effects of epidural clonidine and neostigmine following intrathecal labour analgesia: a randomised, double-blind, placebo-controlled trial

Van de Velde, M.; Berends, N.; Kumar, A.; Devroe, S.; Devlieger, R.; Vandermeersch, E.; De Buck, F.

doi:10.1016/j.ijoa.2009.01.003

« Previous Next »International Journal of Obstetric Anesthesia
Volume 18, Issue 3 , Pages 207-214, July 2009

Effects of epidural clonidine and neostigmine following intrathecal labour analgesia: a randomised, double-blind, placebo-controlled trial☆

M. Van de Velde
- Department of Anaesthesiology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
- Correspondence to: Marc Van de Velde, MD, PhD., Director Obstetric Anaesthesia and Extra Muros Anaesthesia, Department of Anaesthesiology, University Hospitals Leuven, Herestraat 49, B - 3000 Leuven, Belgium. Tel.: 0032 16 34 42 70; fax: 0032 16 34 42 45.
N. Berends
- Department of Anaesthesiology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
A. Kumar
- Department of Anaesthesiology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
S. Devroe
- Department of Anaesthesiology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
R. Devlieger
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
E. Vandermeersch
- Department of Anaesthesiology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
F. De Buck
- Department of Anaesthesiology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium

Accepted 7 January 2009. published online 18 May 2009.

Abstract

Background

The limited duration of spinal labour analgesia combined with problems associated with maintenance of epidural analgesia, have prompted the search for combinations that could prolong spinal analgesia. A randomised, double-blind trial was carried out to test the hypotheses (a) that initial spinal labour analgesia is prolonged by administering clonidine and neostigmine epidurally whilst (b) the hourly local anaesthetic consumption is reduced.

Methods

Seventy labouring patients received spinal analgesia with ropivacaine and sufentanil. Fifteen minutes after spinal injection, 10mL of study solution was administered epidurally. The study solution was plain saline or neostigmine 500μg combined with clonidine 75μg. Outcome parameters were duration of spinal analgesia, local anaesthetic consumption and number of patients delivering without additional epidural analgesia.

Results

Epidural clonidine and neostigmine significantly prolonged initial analgesia: 144 (105–163)min vs. 95 (70–120)min in the placebo group and reduced hourly ropivacaine consumption: 7.5 (3.0–11.9)mg vs. 12.7 (9.6–16.9)mg. More patients in the experimental group delivered before the first request for additional analgesia (9 vs. 2).

Conclusion

Epidural administration of neostigmine 500μg and clonidine 75μg, following the intrathecal injection of ropivacaine and sufentanil, prolongs analgesia and reduces hourly ropivacaine consumption.

Keywords: Ropivacaine, Combined spinal epidural, Labour analgesia, Neostigmine, Clonidine