The Effect of Epidural Clonidine andNeostegminefollowing IntrathecalLabour Analgesia

Abstract

Summary and Conclusion T he combined spinal epidural technique is being increasingly used for labor analgesia, the CSE technique offers several potential advantages including more rapid onset of analgesia with symmetrical spread and greater patient satisfaction. But other advantages such as reduced local anesthetics consumption remain unconfirmed. Both clonidine and neostigmine have been previously investigated as adjuvants to epidural or spinal labor analgesia. Clonidine is α2-receptor agonist, works on the norepinephrine nerve center and can treat high blood pressure. This study aimed to study the effect of epidural administration of various concentrations of neostegmine and clonidine either separately or combined following intrathecal injection of bupivacaine and fentanyl and observes its impact on labour analgesia and local anesthetic consumption. During the study, 80 labouring patients received spinal analgesia with bupivacaine and fentanyl and after fifteen minutes of spinal injection, 10 mL of study solution was administered epidurally. The study solution was plain saline or neostigmine 500 µg combinedwith clonidine 75 µg or neostigmine alone and clonidine alone Outcome parameters were measured including the initial analgesic duration, local anesthetic consumption and number ofpatients delivering without additional epidural analgesia, VAS and mother and neonate adverse effects. The NC groups showed a statistically significant difference according to the initial analgesic duration as the addition of epidural clonidine and neostigmineto an intrathecal mixture prolonged the duration of initial analgesia more than the control, N group as well as the C group. Also, the N group and C group showed statistically higher significant difference than the control (P) group. Significantly, the administration of NC combination resulted in lowering the consumption of the total dose of bupivacaine. Using Clonidine or neostigmine alone with the intrathecal mixture significantly lowers the total consumption of bupivacaine than the control group but still higher than the NC group.The VAS was significantly lower in NC group than other groups with no side effects on maternal and neonatal outcomes. In conclusion, this study showed that the combination of clonidine and neostigmine at a dose ofclonidine 75µg and neostegmine 500µg could significantly prolong the duration of initial spinal analgesia as well as lowering the need for local anesthetic and decreasing the visual analogue scale for pain resulting in patients satisfaction without any obvious adverse outcomes on the maternal and neonatal side.