Abstract
Objectives. To compare the analgesic efficacy of intrathecal clonidine and fentanyl added to bupivacaine after cesarean section. Methods. Ninety patients scheduled for cesarean section under spinal anesthesia were randomly allocated to one of the three following groups to receive bupivacaine 10 mg combined with 75 µg clonidine (group C), bupivacaine 10 mg combined with 0.5 mL fentanyl (group F), and bupivacaine 10 mg combined with 0.5 mL distilled water (group P), intrathecally. The time to first analgesic request, analgesic requirement in the first 24 hours after surgery, sensory and motor blockade onset time, duration of sensory and motor blockade, the incidence of hypotension, ephedrine requirements, bradycardia, and hypoxemia were recorded. Results. The duration of anesthesia in clonidine group (275.10 ± 96.09) was longer compared to the placebo (211.73 ± 74.80) and fentanyl (192.33 ± 30.36) groups. This difference between group C versus F (P = 0.006) and P groups (P < 0.001) was significant. Similarly, the mean time to first analgesic request was also longer in group C (519.44 ± 86.25) than in groups F (277.88 ± 94.25) and P (235.43 ± 22.35 min). This difference between group C versus F (P < 0.001) and P groups (P < 0.001) was significant. Conclusion. Intrathecal clonidine 75 µg with bupivacaine prolonged the time to first analgesic request compared to fentanyl; however, the total analgesic consumption within the first 24 h postoperative was similar in fentanyl and clonidine groups following cesarean section. This trial is registered with ACTRN12611000909921 and ClinicalTrials.gov NCT01425658.
Highlights
Pain control after cesarean improves breastfeeding and satisfaction of mother
The clonidine group received bupivacaine 10 mg combined with 75 μg of preservative free clonidine; the fentanyl group received bupivacaine 10 mg combined with 25 μg fentanyl; and the placebo group received bupivacaine 10 mg combined with 0.5 mL distilled water, intrathecally
There were no significant differences in age, height, and weight among the three groups
Summary
Pain control after cesarean improves breastfeeding and satisfaction of mother. In addition, inadequate analgesia leads to elevated plasma catecholamine concentrations, resulting in adverse effect on all organ systems [1]. Neuraxial analgesia using only local anesthetic often provides suboptimal analgesia with higher side effects. Many drugs have been adjusted to local anesthetics to provide optimal analgesia with lower side effects such as opioids, epinephrine, ketamine, midazolam, clonidine, and magnesium [2, 3]. Opioids are usually used for providing better analgesia and reducing the side effects. Fentanyl exhibits close structural similarities to local anesthetics and has demonstrable local anesthetic effect on sensory C primary afferent nerve fibers, which may facilitate analgesic effects [4, 5]. Fentanyl is the most frequently intrathecal lipophilic opioid used as analgesic agent with minimal cephalad spread making it the least likely of all the intrathecal opioids to cause delayed respiratory depression [5].
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