Intrathecal dexmedetomidine for cesarean delivery and postoperative outcomes: a single-center retrospective cohort...

Intrathecal opioids are the standard adjuvant for spinal anesthesia in cesarean delivery, but investigating alternatives is warranted. A community hospital began adding intrathecal dexmedetomidine 10 µg to spinal anesthetics for cesarean deliveries due to a local shortage in opioids. This retrospective study evaluates its impact on postoperative pain, opioid use, and hemodynamic outcomes.

After IRB approval, cesarean delivery cases conducted between 2019 and 2020 were screened. Exclusion criteria included epidural labor analgesia, general anesthesia, intrathecal catheters, or intrathecal dexmedetomidine dose other than 10 µg. Primary outcome was postoperative pain score; secondary outcomes included opioid use (in milligram morphine equivalents), incidence of intraoperative hypotension, vasopressor use, postoperative mean arterial pressure, Apgar scores, and length of stay.

Of 572 cesarean deliveries, 414 met inclusion criteria; 163 received 10 µg of intrathecal dexmedetomidine, 251 did not. Demographics were similar. Patients who received intrathecal dexmedetomidine 10 µg had significantly lower postoperative pain scores (effect size -0.41, 95% CI -0.18 to -0.64; P < 0.001). Opioid use was significantly reduced 0-6 h after anesthesia (15.0 mg vs. 22.5 mg; P < 0.001) and 6-24 h after anesthesia end (26.1 mg vs. 29.4 mg; P = 0.0465). However, there was a higher incidence of intraoperative hypotension (44.2% vs. 28.3%; P < 0.001).

Intrathecal dexmedetomidine 10 µg was associated with reduced postoperative pain and opioid use, supporting its role as an intrathecal adjuvant. However, its association with increased hypotension highlights the need for cautious use and further investigation.