Low-dose clonidine and neostigmine prolong the duration of intrathecal bupivacaine-fentanyl for labor analgesia

Abstract

Background: Intrathecal (IT) opioid and local anesthetic combinations are popular for labor analgesia because of rapid, effective pain relief, but the duration of analgesia is limited. This study was undertaken to determine whether the addition of clonidine and neostigmine to IT bupivacaine-fentanyl would increase the duration of analgesia without increasing side effects for patients in labor. Methods: Forty-five healthy parturients in active labor were randomized to receive a 2-ml IT dose of one of the following dextrose- containing solutions using the combined spinal-epidural technique: (1) bupivacaine 2.5 mg and fentanyl 25 μg (BF); (2) BF plus clonidine 30 μg (BFC); or (3) BFC plus neostigmine 10 μg (BFCN). Pain, sensory levels, motor block, side effects, maternal vital signs, and fetal heart rate were systematically assessed. Results: Patients administered BFCN had significantly longer analgesia (165 ± 32 min) than those who received BF (90 ± 21 min; P < 0.001) or BFC (123 ± 21 min; P < 0.001). Pain scores, block characteristics, maternal vital signs, Apgar scores, maternal satisfaction, and side effects were similar among groups except for nausea, which was significantly greater in the BFCN group (P < 0.05 as compared with BFC). Conclusions: The addition of clonidine and neostigmine significantly increased the duration of analgesia from IT bupivacaine-fentanyl during labor, but neostigmine caused more nausea. Although serious side effects were not observed in this study, safety must be further addressed before the routine use of multiple IT drugs is advocated.