Dexmedetomidine Added to Bupivacaine Versus Bupivacaine Alone in Spinal Anesthesia for Cesarean Section

Introduction: Neuraxial anesthesia became the first option in Cesarean delivery. Different additives to bupivacaine were used to prolong the duration of analgesia after spinal anesthesia specially opioids and α2 agonists. The effects of intrathecal dexmedetomidine (DEX) on the perioperative clinical profile of bupivacaine-induced spinal anesthesia were not studied before in the obstetric patient population.Methods: A randomized controlled trial was conducted in obstetric department in Cairo University Hospitals during the year 2015. Sixty patients were enrolled where they are divided into two groups, one group received intrathecal bupivacaine (group B) and the other group received bupivacaine plus 5mg DEX (group BD5).The time to two sensory block segment regression, the peak sensory level of the block, the time to S 1 level sensory regression, the intraoperative and early postoperative hemodynamic variables, and side effects e.g. nausea and vomiting were measured.Results: The mean time to two segment dermatomal regression showed a statistically significant difference between group BD5 (130±27) min compared to group B (74±16.5) min (p=0.000). The mean time of sensory regression to S1 showed statistically significant prolongation in group BD5 (317.3±51.5) min compared to group B (254±66.5) min (p=0.000). There was no significant difference between the two groups regarding hemodynamics, sedation or side effects.Results: The mean time to two segment dermatomal regression showed a statistically significant difference between group BD5 (130±27) min compared to group B (74±16.5) min (p=0.000). The mean time of sensory regression to S1 showed statistically significant prolongation in group BD5 (317.3±51.5) min compared to group B (254±66.5) min (p=0.000). There was no significant difference between the two groups regarding hemodynamics, sedation or side effects.Conclusion: The addition of DEX 5mg as an intrathecal adjuvant to isobaric bupivacaine 0.5% in elective Caesarean section achieved better intra operative conditions and prolonged postoperative analgesia with absence of sedation than those who received only bupivacaine with no effect on the neonatal outcome and without causing hemodynamic instability.