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Optimal dose of intrathecal clonidine added to sufentanil plus bupivacaine for labour analgesia

From the Department of Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229 899, Singapore.

Address correspondence to: Dr. A.T.H. Sia. Fax: 65-291-2661; E-mail: athsia{at}kkh.com.sg

Purpose: The combination of intrathecal (IT) 5 µg sufentanil plus 1.25 mg bupivacaine is useful for inducing labour analgesia, albeit of short duration and slow onset. As a supplementation to this regimen, the effect of IT clonidine on the duration of analgesic action was investigated.

Methods: Forty-eight healthy parturients were randomly assigned into three groups to receive 0 µg (group C0), 15 µg (C15) or 30 µg (C30) of clonidine IT in addition to 5 µg sufentanil plus 1.25 mg bupivacaine IT for labour analgesia. The quality of pain relief was assessed on 0-100 visual analogue scale by the author. The occurrence of side effects was also evaluated before the request for additional analgesia.

Results: Clonidine (C15 and C30), produced a longer duration of analgesia than C0 (mean 144 ± sd 27.9, 165 ± 31.8 vs 111 ± 21.9 min, P < 0.01). Also, C15 and C30 produced a more rapid onset and a higher quality of analgesia than C0, (P < 0.01). The most cephalad level of sensory block was higher in C30 than C15 (median T3 vs T4, P < 0.05) but lowest in C0 (median T7 vs T3,T4, P < 0.01). Side effects, sedation and hypotension, occurred more frequently in C30 than in either C0 or C15, (9 vs 2,5 and 9 vs 1,3, respectively, P < 0.05).

Conclusion: The optimal dose of intrathecal clonidine to enhance labour analgesia with the current sufentanil-bupivacaine regimen is 15 µg. In view of the side effect profile, doses greater than 30 µg clonidine are unlikely to be useful.

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