Comparison of Local Subcutaneous Infiltration with Ropivacaine Alone and Two Different Doses of Dexmedetomidine Plus Ropivacaine for Postoperative Pain after Cesarean Section Under Spinal Anesthesia.

Abstract

Background: In a cesarean section (CS), good postoperative pain management is of great importance. We assessed the effect of adding dexmedetomidine to ropivacaine 0.5% in CS patients with spinal anesthesia to assess its ability to enhance pain management.

Materials and methods: This was a randomized controlled trial in Shahid Beheshti Hospital between 2022 and 2023 with the goal of assessing ropivacaine efficacy with and without dexmedetomidine on pain control after a CS. Spinal anesthesia was administered for all patients by using bupivacaine 0.5%. Before wound closure, patients were treated with analgesics. Group A received dexmedetomidine 1 µg/kg infiltrated subcutaneously, followed by ropivacaine 0.5% 3 mg/kg diluted with normal saline to 40 cc. Group B received dexmedetomidine 2 µg/kg, followed by ropivacaine 0.5% 3 mg/kg. The control group received ropivacaine 0.5% 3 mg/kg. A P value of < 0.05was regarded as significant.

Results: The study groups exhibited significantly lower visual analog scale (VAS) pain scores. Specifically, group A showed significantly lower VAS scores than the controls, and group B also showed significantly lower VAS scores than group A. The VAS score after 24 hours of CS was, on average, 2.13 (SD = 0.16, 95% CI = [1.74, 2.52]) lower in group B compared to the control group and 1.1 (SD = 0.16, 95% CI = [0.71, 1.49]) lower than in group A (P < 0.05).

Conclusions: Subcutaneous infiltration of dexmedetomidine with ropivacaine improves postoperative pain management more effectively than using ropivacaine alone. It is noteworthy that dexmedetomidine 2 µg/kg can improve pain after a CS more effectively than 1 µg/kg.