Abstract
Background
Alpha-2 agonist, e.g. dexmedetomidine, is a non-opioid adjuvant with a substantial role in extending the analgesic duration of the subarachnoid block. Here, we aim to test the efficacy of adding dexmedetomidine to hyperbaric bupivacaine in the caesarean delivery, targeting enhanced postoperative analgesia and more stable hemodynamics.
Methods
40 parturient women scheduled for elective caesarean section were enrolled and randomly allocated to two groups. Low Dose – Dexmedetomidine (LD- DEX) group (n = 20) received 7 mg hyperbaric bupivacaine plus 10 µg dexmedetomidine, control group (n = 20) received 12 mg hyperbaric bupivacaine. Continuous normally distributed data were expressed as mean and standard deviation. Ordinal data and continuous data not fitting to the normal distribution curve were presented as medians (range) meanwhile categorical data were reported as percentage of the total number. Regarding the autonomic variables, we did a stratified analysis to compare the mean change of these variables every 3 minutes till 60 minutes through a two-sample t-test (Welch t-test). All statistical analyses were performed using R software version 3.4.4
Results
LD- DEX groups showed significant faster and prolonged sensory block (P-value < 0.05), stable maternal hemodynamic maintained by less amount of IV fluids (P-value < 0.01), lower doses of ephedrine (P-value = 0.02), no signs of foetal distress, and low incidence of postoperative maternal shivering. As well, 3 hours cut off pain was more significant in LD- DEX group (P-value < 0.01).
Conclusion
LD- DEX group provided an optimum intraoperative condition and postoperative analgesia with less maternal side effects and no neonatal risks, encouraging enhanced recovery and less hospital in-stay.
Comparative study with or without application of enhanced recovery after surgery protocols in patients undergoing elective cesarean section