title: Intraoperative conditions and quality of postoperative analgesia after adding dexmedetomidine to epidural bupivacaine and fentanyl in elective cesarean section using combined spinal-epidural anesthesia.
abstract: This study was designed to evaluate the effect of adding dexmedetomidine to regular mixture of epidural drugs for pregnant women undergoing elective cesarean section with special emphasis on their sedative properties, ability to improve quality of intraoperative, postoperative analgesia, and neonatal outcome.
  
  
  METHODS
  Fifty women of ASA physical status I or II at term pregnancy were enrolled randomly to receive plain bupivacaine plus fentanyl (BF Group) or plain bupivacaine plus mixture of fentanyl and dexmedetomidine (DBF Group). Incidence of hypotension, bradycardia, Apgar scores, intraoperative pain assessment, onset of postoperative pain, sedation scores, and side effects were recorded.
  
  
  RESULTS
  No difference in the times taken for block to reach T4 sensory level, to reach the highest level of sensory block, and interval between first neuraxial injection and onset of surgery between the groups was noted. Onset of postoperative pain was significantly delayed in the DBF group (P = 0.001), the need for supplementary fentanyl was significantly less in DBF group (P = 0.03), no significant difference was noted between both groups regarding neonatal Apgar scores as well as the incidence of hypotension, bradycardia, nausea, vomiting, and duration of motor blockade. DBF group had significantly less incidence of shivering (P = 0.03).
  
  
  CONCLUSIONS
  Adding dexmedetomidine to regular mixture of epidural anesthetics in women undergoing elective cesarean section improved intraoperative conditions and quality of postoperative analgesia without maternal or neonatal significant side effects.
authors.affiliation: Department of Anesthesia and Intensive Care, Faculty of Medicine, AL-Azhar University, Cairo, Egypt.
authors.forename: Samy Elsayed
authors.initials: SE
authors.lastname: Hanoura
authors.affiliation: Department of Obstetric and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
authors.forename: Rabei
authors.initials: R
authors.lastname: Hassanin
authors.affiliation: Department of Biostatistics, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Rajvir
authors.initials: R
authors.lastname: Singh
keywords: Combined spinal-epidural anesthesia; elective caesarean section; epidural dexmedetomidine