Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Abstract

The aim of the present study was to evaluate the effectiveness and safety of the combination of epidural dexmedetomidine and morphine in providing anesthesia during cesarean surgery and analgesia for post-cesarean pain relief when added to epidural ropivacaine. A total of 80 females at term scheduled for elective cesarean delivery were randomly assigned to two groups (n=40/group): In the morphine group (group M), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) for surgical anesthesia, and epidural infusion of morphine (2 mg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia; and in the morphine combined with dexmedetomidine group (group DM), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) combined with dexmedetomidine (0.5 µg/kg) for surgical anesthesia, and epidural infusion of morphine (2 mg) and dexmedetomidine (200 µg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia. The primary outcomes included blockade and analgesic effects, sedation and adverse reactions associated with the drugs. Neonatal outcome was also assessed by determining the Apgar score and umbilical cord blood analysis. There was no significant difference between the groups in the cephalad levels of sensory blockade at 20 min post-injection, or in muscle relaxation scores or pain intensity scores at rest or upon movement at 4, 12, 24 or 48 h post-injection (P>0.05). The maternal patients in the DM group experienced more complete motor blockade at 20 min post-injection, better sedation during surgery and following delivery, and less visceral pain caused by peritoneal traction during surgery and by uterine contraction after delivery, compared with those in group M (P<0.05). The patients in group M had a lower incidence and severity score of post-operative nausea than those in the DM group (P<0.05). There was no significant difference between the groups in terms of Apgar score or umbilical cord blood gas values (P>0.05). In conclusion, epidural dexmedetomidine reduces intra-operative and post-operative visceral pain and produces better sedation during surgery and following delivery, without any significant influence on morphine-associated side effects and post-operative analgesia, in females undergoing elective cesarean section under epidural anesthesia with morphine and ropivacaine (registration number ChiCTR1900027942; retrospectively registered with the Chinese Clinical Registry Center on December 6, 2019).

Analysis of Anesthesia Effect of Dexmedetomidine in Clinical Operation of Replantation of Severed Finger

“…The two groups of patients received routine oxygen inhalation by mask during the operation. After the operation, the intravenous self-control pump was turned on, and the two groups had the same formula [ 21 ].…”

Incidence of Hypotension and Associated-risk Factors in Epidural Anesthesia With 2% Lidocaine and Epinephrine During Elective Cesarean Section, Efficacy and Safety Assessment

“…Welker et Al [37] found a visceral pain rate of 17% when EPA was performed with bupivacaine in lateral decubitus position. E. Bjornestad and coworkers [29] found 20% and 30% of visceral pain in their study with epidural lidocaine and epidural 2-chloroprocaine respectively, while Yicheng Yang and colleagues [38] found an intraoperative pain incidence ranged at 70% and 47.5% respectively in epidural ropivacaine-morphine and epidural ropivacaine-morphinedexmedetomidine. It is actually known that epinephrine has some properties of antinociceptive and enhances the duration of analgesia used together with LAs [39,40] .…”

“…Our results are similar to those of Chantal T. Crochetière and coworkers [32] . Other researchers have considered abnormal Apgar score or acidosis with Apgar score < 7 [27,38,47,48] . In their study for epidural anesthesia, comparing ropivacaine and bupivacaine effects for scheduled CS, Sandra Kampe et al [27] found some cases of neonates with Apgar score less than 7.…”

Effect of dexmedetomidine on oxytocin‐induced uterine contraction during optimal caesarean section anaesthesia

“…Dexmedetomidine, as a highly selective α‐2 adrenergic receptor agonist, can effectively attenuate noradrenergic effects by inhibiting the binding of α‐2 presynaptic adrenergic receptors to the locus coeruleus in the brain. Dexmedetomidine can be administered both intravenously and intrathecally in obstetric anaesthesia 16–18 to optimize anaesthesia, reduce intraoperative stress and adverse reactions and ensure the safety of the infant and breastfeeding 7,19 . In addition, it has certain organ protective effects in subjects with preeclampsia, pulmonary hypertension in pregnancy and hyperthyroidism 20–23 .…”