Patient-controlled epidural analgesia in labour: the addition of fentanyl or clonidine to bupivacaine.

In this study, we studied 45 healthy parturients with singleton vertex presentation. Patients were allocated randomly to receive either 0,125 % bupivacaine with 2 micro g/ml fentanyl or 0,125 % bupivacaine with 1,5 micro g/ml clonidine for epidural labour analgesia. A patient controlled epidural analgesia (PCEA) pump was programmed as follows: basale infusion rate: 6 ml/h, demand bolus: 5 ml, lockout interval: 10 min. Efficacy of analgesia was evaluated using visual analogue scale. Maternal and fetal cardiovascular variables, Apgar scores of the newborn at 1-5 min and umbilical arterial blood gas measurements were recorded. The duration of stages of labour and total analgesic consumption were also noted. Systolic blood pressure decreased significantly at 3rd h in bupivacaine plus fentanyl group. Although all patients experienced a good analgesia, pain scores in bupivacaine plus clonidine group were lower than bupivacaine plus fentanyl group. The analgesic requirement in bupivacaine plus clonidine group was less than the other group. There were no significant differences in fetal heart rate, Apgar scores or umbilical blood gases. In conclusion, the addition of clonidine to epidural bupivacaine for PCEA was superior to bupivacaine plus fentanyl for analgesia and analgesic requirement during labour.