In this study, we evaluated the efficacy and safety of an epidural single dose of fentanyl alone, or, in combination with clonidine, or, and neostigmine to provide selective and balanced analgesia during first stage of labor. Eighty healthy parturients were randomly allocated to receive, after a test dose, a single epidural injection of either 125 ug fentanyl, 50 ug fentanyl plus 75 ug clonidine, 50 ug fentanyl plus 500 ug neostigmine, or a combination of epidural 50 ug fentanyl plus 75 ug clonidine and 500 ug neostigmine was given in a total volume of 12 ml. Pain score, onset and duration of analgesia were determined. Maternal and fetal vital parameters as well as side effects were closely monitored. We found that a combination of epidural fentanyl 50 ug with 75 ug clonidine, or, 500 ug neostigmine, produced effective analgesia in 50% of parturients within 10 min and in 60% within 20 min with average duration of 105 & 121 min respectively. But whom received 125 ug fentanyl alone had delayed onset of analgesia “10% of parturients within 10 min and 50% within 20 min” with shorter duration of analgesia “average 87.6 min”. However, combination of epidural 50 ug fentanyl with 75 ug clonidine and 500 ug neostigmine had resulted in rapid onset of analgesia “50% of parturients within 10 min and in 75% within 20 min” with average duration of analgesia 123.9 min. We also found that with any combination of the studied drugs, there was ropivacaine sparing effect and no motor block was observed. Maternal sedation in 25% of parturients received epidural 125 ug fentanyl. Maternal hypotension in 25% of parturients received fentanyl and clonidine. However, we observed that epidural neostigmine counteracts hypotension induced by epidural clonidine. Nausea and vomiting were not significantly higher between parturients received epidural neostigmine in comparison with whom did not. No adverse effects had been seen on the fetus and fetal vital parameters remained stable during labor in all of the studied groups. |
