الفهرس 
The Stages and Physiology of Normal Labour
Efficiency in labourOnly 14 pages are availabe for public view
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Abstract
The Effect of Epidural Clonidine and Neostegmine Following Intrathecal Labour Analgesia
Galal A. El kadi, Amr M. Abdel Fatah, Waleed A. Ibrahim, Abdel Rahman M. Shoukry
Abstract
Introduction: Clonidine, an -2 adrenceptor agonist that can be used as a spinal analgesic whose administration does not induce motor impairment, produce analgesia through nonopioid mechanism and is therefore devoid of adverse effect such as nausea, pruritis or respiratory depression. Furthermore, use of clonidine allows a subsequent local anesthetic sparing effect throughout the course of labor. Neostegmine a choline esterase inhibitor was evaluated as spinal analgesic in various acute pain conditions, including laboring parturient. Clonidine and neostegmine possess common mechanism of action through spinal release of acetylcholine. Reducing local anesthetics consumption is of clinical importance as it may reduce side effects and improve patient satisfaction.
Patients and methods: This was a randomized control prospective study conducted on 80 pregnant ladies who are matching the inclusion criteria assigned randomly to 4 group search containing 20 parturients admitted to study the effect of epidural administration of various concentrations of neostegmine and clonidine either separately or combined following intrathecal injection of bupivacaine and fentanyl and observes its impact on labour analgesia and local anesthetic consumption.
Results: Combination of Epidural clonidine and neostigmine significantly prolonged initial analgesia and reduced bupivacaine consumption more than the control, neostegmine group as well as the clonidine group.
Conclusion: The combination of clonidine and neostigmine at a dose of clonidine 75µg and neostegmine 500µg could significantly prolong the duration of initial spinal analgesia as well as lowering the need for local anesthetic and decreasing the visual analogue scale for pain resulting in patients satisfaction without any obvious adverse outcomes on the maternal and neonatal side.
Leighton BL and Halpern SH. (2007): Epidural analgesia and the progress of labor. In: Evidence-based obstetric anesthesia: Blackwell Publishing Ltd. p 10-22.
Simmons SW, Taghizadeh N, Dennis AT, Hughes D, Cyna AM. (2012): Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev 10:Cd003401.
Van de Velde M, Berends N, Kumar A, Devroe S, Devlieger R, et al., (2009): Effects of epidural clonidine and neostigmine following intrathecal labour analgesia: a randomised, double-blind, placebo-controlled trial. Int J Obstet Anesth 18:207-214.
Key wards: Clonidine, Neostegmine, Epidural, Labour analgesia.