Effect of mini-dose epidural dexmedetomidine in elective cesarean section using combined spinal-epidural anesthesia: a randomized double-blinded controlled study

Abstract

Background: Combined spinal-epidural anesthesia is commonly used for elective cesarean section. Our study aimed to evaluate the effect of adding dexmedetomidine to epidural bupivacaine and fentanyl in patients undergoing elective cesarean section using combined spinal-epidural anesthesia.

Methods: Eighty healthy women at term were randomly assigned to two groups: a control group (n = 40; "Bup/Fen group") received combined spinal-epidural anesthesia with intrathecal hyperbaric bupivacaine 5 mg and an epidural mixture of 10 mL plain bupivacaine 0.25 % and fentanyl 50 μg, whereas the study group (n = 40; "Dex/Bup/Fen group") received 1 mL epidural dexmedetomidine 0.5 µg/kg in addition. The primary outcome measure was the difference between the groups in the supplementary fentanyl analgesic required. The quality of surgical anesthesia, incidences of hypotension and bradycardia, APGAR scores, intraoperative pain assessment, and onset of postoperative pain, sedation score, and side effects were recorded.

Results: There was no statistically significant difference between the groups regarding block characteristics. Significantly less intraoperative and postoperative fentanyl were required by the Dex/Bup/Fen group (P = 0.015 and P = 0.0011, respectively). There was no statistically significant difference between the groups regarding sedation score or the incidences of hypotension, nausea and vomiting, dizziness, and pruritus.

Conclusions: The addition of mini-dose epidural dexmedetomidine 0.5 µg/kg as a single injection to bupivacaine fentanyl in women undergoing elective cesarean section with combined spinal-epidural anesthesia improved intraoperative conditions and the quality of postoperative analgesia.

Keywords: Combined spinal–epidural anesthesia; Dexmedetomidine.