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Epidural clonidine analgesia after cesarean section
R Mendez1, J C Eisenach, K Kashtan
1Department of Anesthesia, Wake Forest University Medical Center, Winston-Salem, North Carolina 27103.
Anesthesiology
|November 1, 1990
Summary
Epidural clonidine effectively reduces pain after cesarean section, decreasing the need for supplemental morphine. Continuous infusion is necessary for pain relief lasting over six hours.
Area of Science:
- Anesthesiology
- Pharmacology
- Obstetrics
Background:
- Epidural clonidine is a potential analgesic for postoperative pain.
- Cesarean section frequently requires effective pain management strategies.
Purpose of the Study:
- To evaluate the efficacy, safety, and optimal dosage of epidural clonidine for post-cesarean section analgesia.
- To compare different doses of epidural clonidine against a placebo.
Main Methods:
- A double-blind, placebo-controlled study involving 60 women undergoing cesarean section.
- Random assignment to receive epidural saline, or clonidine (400 mcg bolus + 10 mcg/h infusion, or 800 mcg bolus + 20 mcg/h infusion).
- Patient-controlled intravenous morphine was used for supplemental analgesia.
Main Results:
- Both clonidine regimens improved pain scores and reduced supplemental morphine use in the initial 6 hours compared to saline.
- Only the higher clonidine infusion dose (20 mcg/h) significantly decreased overall 24-hour morphine consumption.
- Clonidine caused dose-dependent decreases in blood pressure, reduced heart rate, and transient sedation; the higher dose prolonged motor blockade.
Conclusions:
- Epidural clonidine provides effective analgesia after cesarean section, evidenced by reduced reliance on supplemental morphine.
- Continuous epidural clonidine infusion is crucial for sustained pain relief beyond 6 hours.
- The 800 mcg bolus with 20 mcg/h infusion appears to be a more effective regimen for 24-hour analgesia, despite potential side effects like prolonged motor blockade.