Effect of dexmedetomidine for epidural supplementation on postpartum sleep disturbance after cesarean delivery: a double-blind, randomized clinical trial.

Background: Dexmedetomidine has been proved to be a supplemental narcotic or/and sedative for neuraxial anesthesia during various obstetrics treatment and operation procedures. Our study aimed to investigate the effect of intraoperative low-dose dexmedetomidine epidural supplementation on postpartum sleep quality and the incidence of postpartum sleep disturbance in patients undergoing cesarean delivery.

Methods: One hundred and twenty parturients scheduled for elective cesarean delivery with epidural anesthesia were randomized to receive either 1 μg · mL-1 dexmedetomidine or placebo, followed with patient-controlled epidural analgesia with either 0.5 μg · mL-1 dexmedetomidine or placebo, combined with ropivacaine, for up to 2 days. The primary outcome was the incidence of postpartum sleep disturbance on postoperative days 3 defined as numeric rating scale (NRS) score of subjective sleep quality of 6 or higher or Pittsburgh Sleep Quality Index (PSQI) score higher than 5 during the first 3 postoperative nights. Postoperative maternal pain intensity, ropivacaine consumption, and patient-controlled epidural analgesia boluses in 48 h were also recorded.

Results: A total of 120 parturients were randomized to the dexmedetomidine group and the control group. The incidence of postpartum sleep disturbance in the dexmedetomidine group was significantly lower than in the control group on postoperative days 3 (30.0% vs 61.7%; odds ratio [OR], 0.49 [95% CI, 0.32-0.75]; P<0.001), and days 7 (25.9% vs 52.5%; OR, 0.49 [95% CI, 0.30-0.81]; P = 0.003). The NRS score of subjective sleep quality was lower in the dexmedetomidine group than in the control group on postoperative days 3 (P<0.001) and days 7 (P = 0.001). The NRS score of subjective sleep quality and the incidence of postpartum sleep disturbance on postoperative days 14 did not differ between the two groups. The Pittsburgh Sleep Quality Index (PSQI) score, the insomnia severity index score, the self-rating anxiety scale, and the Edinburgh Postnatal Depression Scale (EPDS) on postoperative days 42 did not differ between the two groups. The NRS score of pain was lower in the dexmedetomidine group than those in the control group at the time of end of surgery, 1 h after surgery, 1 d after surgery, 2 d after surgery, and 3 d after surgery (P<0.001); postoperative ropivacaine consumption (mg) and patient-controlled epidural analgesia boluses (n) in 48 h were lower in the dexmedetomidine group than that in the control group (P<0.001).

Conclusions: Intraoperative and postoperative continuous epidural infusion of low-dose dexmedetomidine significantly improved postpartum sleep quality, reduced the incidence of postpartum sleep disturbance, which may be associated with optimized analgesia effect and decreased postoperative ropivacaine consumption in parturients undergoing elective cesarean delivery. Further studies are needed to confirm these results.