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Intrathecal dexmedetomidine for cesarean delivery: a scoping review
P Vozzo1, S Zilber2, R Landau1
1Department of Anesthesiology, Columbia University Irving Medical Center, New York, USA.
International Journal of Obstetric Anesthesia
|August 29, 2025
Summary
Intrathecal dexmedetomidine shows promise for cesarean delivery pain management, but current research quality is poor. Further studies are needed to establish optimal use and address knowledge gaps in multimodal analgesia.
Area of Science:
- Anesthesiology
- Obstetrics
- Pharmacology
Background:
- Intrathecal dexmedetomidine (ITDex) is increasingly considered for pain management during cesarean delivery.
- Recent guidelines suggest its off-label use, prompting a review of existing evidence.
Purpose of the Study:
- To identify all publications on ITDex for cesarean delivery.
- To evaluate the evidence quality and characterize outcomes associated with ITDex use.
Main Methods:
- A scoping review following PRISMA-Scr guidelines was conducted.
- Searches of PubMed and Embase identified relevant randomized controlled trials (RCTs) and observational trials.
- Data extraction focused on study characteristics and clinical outcomes.
Main Results:
- 48 publications (2015-2024) were identified, including 43 RCTs, involving 2,002 patients.
- Doses of ITDex ranged from 1-35 μg; common outcomes reported included shivering, block characteristics, and postoperative analgesia.
- Few studies reported on pain during cesarean delivery, and none incorporated current multimodal opioid-sparing regimens.
Conclusions:
- ITDex may be a valuable intrathecal adjuvant for cesarean delivery.
- However, the quality of study design and data reporting is critically poor.
- Significant knowledge gaps persist regarding optimal dosing and integration into multimodal analgesia protocols.
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