Dexmedetomidine as an Adjuvant for Spinal Anesthesia in Parturients Undergoing Cesarean Section: A Narrative Review

Adequate postoperative analgesia is imperative in cesarean delivery to manage postoperative pain, promote timely functional recovery, and optimize patient satisfaction. Spinal-administered local anesthetic combined with opioids is the mainstay technique to provide adequate analgesia to block visceral pain. The purpose of this narrative review is to offer an effective alternative adjuvant to opioids for intraoperative sensory and motor block and prolonged postoperative analgesia. While not yet FDA-approved for labor and delivery nursing, dexmedetomidine, a potent α-2 agonist, has emerged as a popular alternative to opioids, and its use in obstetric anesthesia has grown.

A systematic review was performed of the existing literature between 2015-2025.

A comprehensive search of PubMed, EMBASE, and CINAHL was executed. The query used Medical Subject Heading, truncated phrases and Boolean logic. Duplicates were removed and eligibility criteria were applied. The search yielded 12 RCTs and two meta-analyses with sample sizes from 4-300 patients ages 18 and older.

Evidence suggests that intrathecal dexmedetomidine may enhance neuraxial blockade resulting in rapid onset, prolonged block, and superior perioperative analgesia. Some evidence also demonstrates that intrathecal dexmedetomidine also reduces nausea, shivering, pruritis, and provides better hemodynamic control.

Intrathecal dexmedetomidine provides adequate neuraxial blockade and significant analgesia while sparing opioid use. In the context of an opioid epidemic in the U.S., opioid-sparing regional anesthesia for cesarean section may promote early maternal recovery and positive neonatal outcomes.