Abstract

Today, spinal anesthesia (SA) is the preferred anesthetic for elective cesarean section (CS). Spinal anesthesia includes local anesthetics (LAs)and many potential additives. Increased interest has emerged in clonidine as an adjuvant to local anesthetics. In doses ranging from 15-100 mcg, clonidine has the potential to prolong the duration of blockade, shorten onset time, potentiate the quality of the spinal and decrease local anesthetic dose requirement. The risk associated with inadequate control of acute postoperative pain after CS is attributed to an increased incidence of persistent pain for up to 8 weeks postpartum.

The case study presented a unique anesthetic where low levels of sedation and additional pain support could have been beneficial. Based on current and scientifically valid evidence, the use of intrathecal clonidine is supported in doses of 15-30 mcg to increase the quality of SA. This is evidenced by prolonged postoperative analgesia effects and two-segment regression, extended time to first analgesic request, and reduced analgesic doses. Increased sedation and hemodynamic effects were dose-dependent in doses > 45 mcg. No respiratory depression or adverse effects on neonate were discovered with the use of intrathecal clonidine.

A plan is proposed for a pilot study to investigate the role and safety of clonidine in reducing pain while providing low levels of sedation in patients reporting severe anxiety, low pain tolerance, or chronic pain history. Similarly, further research is needed to investigate intrathecal clonidine effectiveness and safety when combined with other additives and LA to provide adequate pain control in patients with low pain tolerance or substance use disorder undergoing CS.

Author Details

Miriam Boulay,RN, BSN Mary Greenway, DNP, CRNA

Sigma Membership

Non-member

Lead Author Affiliation

Samford University, Birmingham, Alabama, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Cesarean Section, Clonidine, Spinal Anesthesia, Alpha 2-Adrenergic Agonist

Advisor

Greenway, Mary Elizabeth

Degree

DNP

Degree Grantor

Samford University

Degree Year

2024

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2024-01-26

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