Sedation with intrathecal clonidine versus fentanyl with bupivacaine in elective cesarean section in a sample of Egyptian parturients

Abstract

Background and objectiveRegional analgesia has become the preferred technique in obstetrics. Spinal analgesia has many advantages, including being a single injection, being easier to administer, and being faster to take effect.Patients and methodsThis study was carried out on 40 parturients scheduled for cesarean sections with spinal analgesia who were categorized as follows: the fentanyl group − 20 parturients received 2 ml of 0.5% hyperbaric bupivacaine and 25 μg fentanyl; and the clonidine group − 20 parturients received 2 ml of 0.5% hyperbaric bupivacaine and 75 μg clonidine. Hemodynamic measurements, sensory blockade, pain intensity using visual analog scale (VAS) and time to first request for analgesia, motor blockade, perioperative side effects or complications, fetal well-being using Apgar score, and both parturient and surgeon satisfaction were recorded and statistically analyzed.ResultsThe parturients who received intrathecal clonidine had a higher level and faster onset of sensory blockade and delayed regression of sensory level compared with those who received intrathecal fentanyl. Regarding the changes in pain intensity measured by VAS, the clonidine group revealed low VAS compared with the fentanyl group immediately after spinal anesthesia and up to 3 h postoperatively with earlier and multiple requests for analgesics in the fentanyl group. On comparing both groups regarding onset of motor block and its regression using the modified Bromage score, we noticed slower onset and regression of motor block in the fentanyl group with longer duration of motor block compared with the clonidine group. Sedation was significantly higher in the clonidine group (25%) than in the fentanyl group. The incidence of nausea and vomiting was significantly higher in parturients who received intrathecal fentanyl (30%) than in those who received intrathecal clonidine (5%) (P<0.05).ConclusionUse of intrathecal clonidine for cesarean section results in better sensory blockade and early recovery of motor blockade as compared with the use of intrathecal fentanyl. Intraoperative sedation is significantly better in the clonidine group.