title: Effect of mini-dose epidural dexmedetomidine in elective cesarean section using combined spinal-epidural anesthesia: a randomized double-blinded controlled study.
abstract: BACKGROUND
  Combined spinal-epidural anesthesia is commonly used for elective cesarean section. Our study aimed to evaluate the effect of adding dexmedetomidine to epidural bupivacaine and fentanyl in patients undergoing elective cesarean section using combined spinal-epidural anesthesia.
  
  
  METHODS
  Eighty healthy women at term were randomly assigned to two groups: a control group (n = 40; "Bup/Fen group") received combined spinal-epidural anesthesia with intrathecal hyperbaric bupivacaine 5 mg and an epidural mixture of 10 mL plain bupivacaine 0.25 % and fentanyl 50 μg, whereas the study group (n = 40; "Dex/Bup/Fen group") received 1 mL epidural dexmedetomidine 0.5 µg/kg in addition. The primary outcome measure was the difference between the groups in the supplementary fentanyl analgesic required. The quality of surgical anesthesia, incidences of hypotension and bradycardia, APGAR scores, intraoperative pain assessment, and onset of postoperative pain, sedation score, and side effects were recorded.
  
  
  RESULTS
  There was no statistically significant difference between the groups regarding block characteristics. Significantly less intraoperative and postoperative fentanyl were required by the Dex/Bup/Fen group (P = 0.015 and P = 0.0011, respectively). There was no statistically significant difference between the groups regarding sedation score or the incidences of hypotension, nausea and vomiting, dizziness, and pruritus.
  
  
  CONCLUSIONS
  The addition of mini-dose epidural dexmedetomidine 0.5 µg/kg as a single injection to bupivacaine fentanyl in women undergoing elective cesarean section with combined spinal-epidural anesthesia improved intraoperative conditions and the quality of postoperative analgesia.
authors.affiliation: Anesthesia Department, Faculty of Medicine, Tanta University, Tanta, Egypt. ayman.yousef@rocketmail.com.
authors.forename: Ayman Abdelmaksoud
authors.initials: AA
authors.lastname: Yousef
authors.affiliation: Gynecology and Obstetrics Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Hesham Abdalaziz
authors.initials: HA
authors.lastname: Salem
authors.affiliation: Gynecology and Obstetrics Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Mostafa Zein
authors.initials: MZ
authors.lastname: Moustafa
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001034:Apgar Score; D002045:Bupivacaine / Q000008:administration & dosage; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D007231:Infant, Newborn; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D011247:Pregnancy; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D020927:Dexmedetomidine; D005283:Fentanyl; D002045:Bupivacaine
keywords: Combined spinal–epidural anesthesia; Dexmedetomidine