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Intravenous dexmedetomidine during cesarean delivery under neuraxial anesthesia: a triple-blind, placebo-controlled

Seishi Sakamoto¹, Manabu Yoshimura^2,3,4, Toshiyuki Nakanishi^1,5

¹Department of Anesthesiology, Japan Community Healthcare Organization Tokuyama Central Hospital, Shunan, Japan.

Journal of Anesthesia

|October 22, 2026

Abstract

Purpose:

Some parturients experience discomfort, pain, and nausea/vomiting during cesarean delivery under neuraxial anesthesia. We evaluated whether intravenous dexmedetomidine administered after fetal delivery and cord clamping improved maternal intraoperative experience.

Methods:

In this prospective, triple-blind, placebo-controlled trial, women aged 20-45 years undergoing elective cesarean delivery under combined spinal-epidural anesthesia were randomized 1:1 to dexmedetomidine or saline. Dexmedetomidine was administered after cord clamping as a loading dose of 1 μg/kg over 10 min, followed by 0.4 μg/kg^/hr until peritoneal closure; controls received equivalent-volume saline. The primary outcome was satisfaction with intraoperative sedation/analgesia, assessed on postoperative day 1 using a 7-point verbal rating scale. Secondary outcomes were Quality of Recovery-40 score, maximum intraoperative pain score, intraoperative nausea/vomiting, and motor recovery time.

Results:

Eighty-three participants were randomized; 81 contributed to the available-case analysis. Satisfaction scores were higher with dexmedetomidine than saline (Hodges-Lehmann location shift, 1.0 point; 95% confidence interval [CI] 1.0 to 2.0; P < 0.001). In ordinal logistic regression, dexmedetomidine was associated with higher satisfaction scores (common odds ratio, 13.4; 95% CI 4.6 to 39.0). Dexmedetomidine reduced intraoperative pain and intraoperative nausea/vomiting, but did not improve 24-h Quality of Recovery-40 scores and modestly prolonged motor recovery.

Conclusion:

Post-delivery intravenous dexmedetomidine improved patient-reported satisfaction with intraoperative sedation and analgesia. Exploratory findings suggested reduced pain and nausea/vomiting without improved 24-h recovery. These findings support further evaluation of dexmedetomidine as a selective adjunct rather than for routine sedation.

Trial Registration:

UMIN000025489 ( https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029334 ).

Keywords:

Cesarean delivery Dexmedetomidine Intraoperative pain Neuraxial anesthesia Randomized controlled trial

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