Skip to main content

Effect of the use of dexmedetomidine as a local anesthetic adjuvant to bupivacaine 0.125% in epidural labor analgesia: randomized controlled study

Abstract

Background

Multiple methods exist for the management of pain during normal labor. Epidural analgesia has been reported to be an effective method in that perspective. The current study was conducted to evaluate the efficacy of dexmedetomidine as an adjuvant to local anesthetics in epidural analgesia for pregnant females presented for normal delivery. Sixty pregnant females were included in this prospective randomized study, and they were divided into two equal groups: control group which received bupivacaine alone and dexmedetomidine group that received bupivacaine with dexmedetomidine. The primary outcome was the onset of analgesia, while the secondary outcomes included the duration of analgesia, hemodynamic changes, labor progress, neonatal outcomes, and maternal complications.

Results

Dexmedetomidine group was associated with earlier onset of analgesia (P ˂ 0.001), prolonged duration (P ˂ 0.001), and lower need for top-up doses (P ˂ 0.001) compared to control group. Also, sedation and maternal satisfaction were significantly better in the same group (P = 0.001, 0.025; respectively). Labor progress parameters and neonatal outcomes were comparable between the two groups. Dexmedetomidine group has lower heart rate and mean arterial blood pressure compared to the control group. Despite of dexmedetomidine group had higher incidence of hypotension and bradycardia, it was statistically insignificant when compared to control group.

Conclusions

Dexmedetomidine is a reliable and an effective adjuvant to the local anesthetics in epidural analgesia during normal delivery as it resulted in earlier onset and significant prolongation of the analgesic time with decrease in the top-up doses intake.

Trial registration

Pan African Clinical Trial Registry (PACTR201710002664704). Register on 3 October 2017.

Background

The majority of females who underwent normal labor have reported that this is one of the most painful life moments. If not well controlled, it can lead to serious consequences for both the mother and the baby (Li et al. 2020; Ali and Wahdan 2018; Keskin et al. 2003).

Multiple methods exist for the management of pain during normal labor including intravenous administration of opioids, neuraxial analgesia, inhaled anesthetics, and even alternative medicine (e.g., transcutaneous electrical nerve stimulation and acupuncture). However, there is a debate about the optimum method that should be used in these ladies as each of the previously described methods has its limitations in this group of population (Ali and Wahdan 2018; Whitburn et al. 2019).

A previous study has reported that epidural analgesia is the most efficacious method for managing labor pain; it can be customized for each pregnant woman to achieve painless labor (Lebovits et al. 2001). Nevertheless, multiple cons have been reported with that technique including motor blockade, hypotension, and prolongation of the second stage of labor (Okholm et al. 2014). Many clinical trials have been done to reduce these effects by choosing optimum local anesthetic concentration with adjuvant drugs.

Dexmedetomidine is a potent alpha-2 adrenergic receptor agonist that is known to have sedative, analgesic along with sympatholytic properties (Zhang et al. 2017). Previous studies have reported that the intrathecal administration of dexmedetomidine led to a significant prolongation of sensory blockage time during cesarean sections and hysteroscopic surgeries (Qi et al., 2016a, b).

This study was conducted to evaluate the efficacy of adding dexmedetomidine to bupivacaine in epidural analgesia in female presented for normal vaginal delivery.

Methods

This prospective randomized blinded study was conducted at the Obstetrics and Gynecology Department over 2 years starting from January 2018 to January 2020. The study was designed for primigravida parturient females aged from 21 to 30 years presented in active labor (cervical dilatation 3-5 cm) to our department, prepared for normal vaginal delivery, and requesting epidural labor analgesia.

The present study included cases with American Society of Anesthesiologists (ASA) (Knuf et al. 2018) class II, having a single pregnancy with vertex presentation, and gestational age > 37 weeks. On the contrary, multigravida or women presenting with mal-presentation, twin pregnancy, preeclampsia, uncontrolled systemic comorbidities (diabetes, renal, hepatic, or cardiac), bleeding diathesis, body mass index (BMI) more than 35 kg/m2, or known allergy to any of the study drugs were excluded.

Sample size was calculated based on the results of a previous trial conducted by Selim and his associates (Selim et al. 2012) which stated that at least 23 cases were required in each group to detect any significant change regarding sensory block onset of 3 min at an alpha value of 0.05 and a 95% study power. To counteract the possibility of the dropout cases, we included 30 cases in each group.

Before participating in the study, all cases were informed about the benefits and risks of epidural analgesia along with the medications used. A written informed consent was obtained after that. Also, the study was approved by the Local Ethical Committee (approval number 31725/08/17) and registered in Pan African Clinical Trial Registration (PACTR201710002664704).

The closed envelope opened after randomization with the computer-generated method. The included 60 women were equally allocated into two groups: control group (30 women) which received bupivacaine 0.125% (10 ml) in normal saline, and dexmedetomidine group (30 women) that received the same amount of bupivacaine in addition to dexmedetomidine 50 μg in normal saline as a loading dose (5 ml increments/5 min). This was followed by continuous infusion of bupivacaine 0.125% (at 10 ml/h rate) for both groups, which was stopped with full cervical dilatation. The epidural solutions were prepared by an anesthesiologist not included in the study. Moreover, all of the following were blinded to group allocation: the patient, the obstetrician, the neonatologist, and the obstetric ward nurse.

All of the included women (in an active second stage of labor with cervical dilatation of 3-5 cm) were commenced on Ringer’s solution (500 ml) as a preload; then, routine baseline monitoring was established including blood pressure (non-invasive), electrocardiography, and pulse oximetry. Also, they were informed how to report their pain degree according to the visual analog scale (VAS) (0 for no pain felt at all, to 10 for the worst pain ever felt).

Later, they were placed in the sitting position with proper sterilization of the back, followed by local infiltration of the skin with underlying subcutaneous tissue overlying lumbar (L) 3-4 and L 4-5 intervertebral disc by lidocaine 2%. The epidural space was reached via an 18-gauge needle (Perifix®, Braun, Germany), and this was ensured using the loss of resistance to air technique. Next, aspiration was done to exclude the presence of blood or cerebrospinal fluid followed by injection of 3 ml of lidocaine 2% as a test dose. After that, a 20-gauge multi-orifice epidural catheter was introduced to about 4-5 cm depth. After securing the catheter over the back by plaster strips, the women were asked to lie in the left lateral position to avoid compression of the inferior caval vein by the pregnant uterus. Injection of the study solution was performed only in between uterine contractions to decrease the risk of drug overspread in the epidural space.

The onset of analgesia was defined as the time needed to achieve a VAS ≤ 3 after injection, while the duration of analgesia was defined as time passing from the time of injection till the woman report a VAS > 3 or breakthrough pain. Both were managed by epidural injection of a top-up dose of bupivacaine 0.125% (5 ml). The top-up doses number were recorded.

The modified Bromage scale was used to assess the degree of motor block (Sari et al. 2015) before installation of the epidural catheter, every 15 min during the 1st hour after installation and then every 30 min till delivery. If Bromage score ≥ 2 was detected, bupivacaine infusion rate was decreased till achieving a score ≤ 1.

The sedation score was used to assess sedation level (Imani et al. 2011) at the same time intervals. This classification allocates patients as agitated, awake and calm, sleepy, mildly sedated, moderately sedated, and deeply sedated using a numerical scale from zero to five for each item respectively.

Both heart rate and arterial blood pressure were monitored and recorded before the installation of the epidural catheter, and 5, 15, 30, 45, and 60 min following its installation and then hourly till the end of delivery. Hypotension, defined as systolic blood pressure < 100 mmHg or a decrease in mean arterial pressure (MAP) > 30% compared to the baseline, and was managed by ephedrine (increment dose 10 mg) along with intravenous fluids. Bradycardia, defined as heart rate (HR) less than 60 beats/m, and was managed by intravenous 0.5 mg atropine.

Cardiotocography was used for fetal heart rate monitoring. If any abnormalities were detected, the mother was asked to change her position to the left lateral one. Also, the mother was commenced on oxygen, intravenous fluids, while oxytocin was stopped. The neonatologist used 1- and 5-min Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score (Li et al. 2013) to assess the neonatal outcome.

The time needed for cervical dilatation, the duration of each stage of labor, and the mode of delivery were recorded. After 24 h of delivery, mother satisfaction was assessed with the five-point Likert’s scale (Voutilainen et al. 2016) as follows: 1 for poor, 2 for fair, 3 for good, 4 for very good, and 5 for excellent satisfaction.

The primary outcome was the onset of analgesia, while the secondary outcomes include the duration of analgesia, hemodynamic changes, labor progress, neonatal outcomes, and maternal complications.

Statistical analysis

Data were entered, tabulated, and analyzed using Statistical Package for Social Science (SPSS) software, version 26.0 for Mac. After testing our data for normality by Kolmogorov-Smirnov and Shapiro-Wilk’s tests, baseline characteristics were described as frequencies and percentages, mean values and standard deviations (SD), or median and range. For comparison of two independent groups of qualitative data, Chi-Square test (or Fisher’s exact test) was applied. Besides, Mann-Whitney U test and independent-samples t test were used to compare two groups of non-parametric and parametric quantitative data respectively. P values < 0.05 were considered statistically significant for all of the used statistical tests.

Results

Sixty pregnant females were included in this study from eligible 72 pregnant females. They were allocated into two equal groups (Fig. 1). Patient’s characteristics and the data of labor progress are illustrated in Table 1.

Fig. 1
figure 1

CONSORT flow chart of the study groups

Table 1 Patient characteristics and labor progress in the study groups

The dexmedetomidine group expressed a significantly earlier onset of analgesia when compared to controls (9.23 vs. 16.8 min; P < 0.001). Additionally, the duration of analgesia was more prolonged in the dexmedetomidine group (169.13 vs. 102.8 min in controls; P < 0.001). Also, the need for top-up doses was significantly decreased in the same group (P < 0.001). No significant difference was detected between the two groups regarding the Bromage scale (P = 0.066). The dexmedetomidine group showed significantly higher sedation score and patient satisfaction compared to the control group (P = 0.001, and 0.025; respectively) (Table 2).

Table 2 Analgesic properties, Bromage scale, sedation, and patient satisfaction in the study groups

As illustrated in Fig. 2, the dexmedetomidine group expressed significantly lower heart rates compared to the control group, starting from 15 min to 2 h. Also, the same group showed significantly lower mean arterial blood pressure starting from 15 min to 1 h.

Fig. 2
figure 2

a Heart rate in the study groups. b Mean arterial blood pressure in the study groups

When it comes to the neonatal outcomes and maternal complications, no significant difference was detected between both groups (Table 3).

Table 3 Neonatal outcomes and maternal complications in the study groups

Discussion

Epidural analgesia is a safe and efficacious technique in pain management during normal labor (Wang and Xu 2020). Multiple medications have been studied as adjuvants to prolong the local anesthetic duration of action with faster onset including opioids (Wang and Xu 2020), dexamethasone (Ali and Wahdan 2018), dexmedetomidine, and clonidine (El-Hennawy et al., 2009).

The epidural injection of alpha 2-agonists such as dexmedetomidine is associated with analgesic, sedative, anxiolytic along with sympatholytic effects (Mauro and Brandão 2004). Its analgesic effects are produced by depressing the release of C-fiber transmitters with postsynaptic dorsal horn neuron hyperpolarization through stimulation of alpha-2 adrenoceptors at the level of substantia gelatinosa of the dorsal horn. It enhances the analgesic properties when injected with local anesthetics (Shaikh and Mahesh 2016; Yoshitomi et al. 2008).

This study was conducted to evaluate the effectiveness of adding dexmedetomidine as a local anesthetic adjuvant in epidural analgesia for normal labor. Although the dose of dexmedetomidine as an epidural adjuvant ranged between 0.5 μg/kg and 1.5 μg/kg (Yousef et al. 2015, Zhao et al. 2017, Selim et al. 2012, Soni 2016) and it is known to cause dose–dependent bradycardia and hypotension, a relatively low fixed-dose (50 μg) was given to all the patients as their weights were within a narrow range to avoid exacerbation of maternal hypotension or bradycardia (Bharti et al. 2018; Alansary and Elbeialy 2019).

In the present study, the dexmedetomidine group reported significantly earlier onset of analgesia compared to the control group (9.23 vs. 16.8 min; p < 0.001). The duration of analgesia was more prolonged in the dexmedetomidine group (169.13 vs. 102.8 min; p < 0.001) than the control group without a significant change in motor block. Besides, the number of top-up doses was significantly decreased in the same group (p < 0.001).

Meta-analysis study conducted by Zhang et al. concluded that adding dexmedetomidine as an adjuvant to local anesthetics in epidural anesthesia resulted in significant prolongation of the analgesic duration with faster onset. This was in agreement with our results (Zhang et al. 2017).

Multiple studies (Kaur et al. 2014; Karhade et al. 2015; Sathyanarayana et al. 2016) have reported that adding dexmedetomidine in epidural anesthesia provides a marked reduction in time to experience sensory and motor block, prolonged duration of the block, and decrease the analgesic requirements. Yang et al. (2020), Hanoura et al. (2013), Mo et al. (2017), and Yousef et al. (2015) have performed their studies on pregnant females undergoing cesarean section and concluded that adding dexmedetomidine potentiates the effect of local anesthetics in epidural anesthesia with minimal maternal side effects. These were in concordance with the results of the present study.

Furthermore, Jun et al. (2018) in their study comparing the effect of adding dexmedetomidine 0.5 μg/ml to ropivacaine 0.1% in epidural labor analgesia concluded that dexmedetomidine group has a better analgesic effect than ropivacaine group. Also, Zhao et al. (2017) combined dexmedetomidine 0.5 μg/kg with ropivacaine 0.125% in epidural analgesia on females undergoing normal labor and they reported a reduction of the feeling of pain without motor block. However, both of these studies differ from the current study as they used ropivacaine and also a different dose of dexmedetomidine.

Moreover, Zhang et al. (2019) demonstrated in their study the effects of dexmedetomidine 0.25 μg/ml and sufentanil 0.25 μg/ml added to ropivacaine 0.1% for epidural labor analgesia. They demonstrated that dexmedetomidine results in a faster onset of analgesia with lower VAS and reduced local anesthetics requirements.

The results of this study showed that the sedation score was significantly higher in the dexmedetomidine group compared to the control group. Epidural dexmedetomidine possesses its sedative property through activation of the spinal cord α2 receptors leading to inhibition of the release of norepinephrine in the locus coeruleus, adding to its systemic absorption due to higher lipid solubility. This property has a great advantage as the patient can be easily aroused so they can participate in the normal delivery process and at the same time decreases maternal anxiety (Zhang et al. 2017). Whatever the sedation score used, many studies have reported the same results (Zhao et al. 2017; 2019; Cheng et al. 2019).

The mean arterial blood pressure and the heart rates were significantly lower in the dexmedetomidine group than the control group; these were of no clinical significance from our point of view as the values were within the normal range and the adverse effects as hypotension and bradycardia were statistically insignificant. Zhao et al. (2017), and Jun et al. (Jun et al. 2018) reported the same results. The decreased value of both parameters could be explained by a better analgesic response in the dexmedetomidine group along with decreased sympathetic outflow as an action of the drug itself (Carollo et al. 2008).

The motor block did not show any significant difference between the two groups, and it did not affect the mode of delivery. The use of low concentration of bupivacaine (0.125%) seems to provide satisfactory analgesia with a Bromage scale of a median value (Li et al. 2020; Rodríguez-Ramón et al. 2015). Adding low dose of dexmedetomidine (50 μg) does not appear to affect the motor block.

As the dexmedetomidine group reported better analgesic efficacy and better sedation score compared to the control group, it was reasonable to report a significant improvement in patient satisfaction with dexmedetomidine administration.

Regarding the labor progress and Apgar score, our results were in line with other studies (Jun et al. 2018; Zhao et al. 2017; Wangping and Ming 2017) that negated any significant difference between the two groups.

One of the limitations in this study is that dexmedetomidine was used as an equal dose (50 μg); for all the patients, it would be more accurate if we use a dose according to the patient’s weight. Additionally, we did not measure the umbilical cord pH used for the assessment of fetal outcomes.

Conclusions

Overall, dexmedetomidine appears to be a reliable and effective adjuvant to the local anesthetics in epidural analgesia during normal delivery as it resulted in earlier onset and significant prolongation of the analgesic time with decrease in the top-up doses intake. In addition, no significant adverse effects were noted either on mother or fetus.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

APGAR score:

Appearance, Pulse, Grimace, Activity and Respiration score

ASA:

American Society of Anesthesiologists

BMI:

Body Mass Index

HR:

Heart Rate

L:

Lumbar

MAP:

Mean Arterial Pressure

SD:

Standard Deviation

SPSS:

Statistical Package for Social Science

VAS:

Visual Analog Scale

References

  1. Alansary AM, Elbeialy MA (2019) Dexmedetomidine versus fentanyl added to bupivacaine for epidural analgesia in combination with general anesthesia for elective lumbar disc operations: a prospective, randomized double-blinded study. Saudi J Anaesth 13(2):119–125. https://doi.org/10.4103/sja.SJA_600_18

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ali HM, Wahdan A (2018) Using dexamethasone as an adjuvant to levobupivacaine in epidural anesthesia to change the pain intensity and duration in painless labor. Saudi J Anaesth 12(2):209–214. https://doi.org/10.4103/sja.SJA_435_17

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bharti N, Pokale SN, Bala I, Gupta V (2018) Analgesic efficacy of dexmedetomidine versus fentanyl as an adjunct to thoracic epidural in patients undergoing upper abdominal surgery: a randomized controlled trial. South African J Anaesth Analg 24(1):16–21. https://doi.org/10.1080/22201181.2018.1433599

    Article  Google Scholar 

  4. Carollo DS, Nossaman BD, Ramadhyani U (2008) Dexmedetomidine: a review of clinical applications. Curr Opin Anesthesiol 21(4):457–461. https://doi.org/10.1097/ACO.0b013e328305e3ef

    Article  Google Scholar 

  5. Cheng Q, Bi X, Zhang W, Lu Y, Tian H (2019) Dexmedetomidine versus sufentanil with high-or low-concentration ropivacaine for labor epidural analgesia: a randomized trial. J Obstet Gynaecol Res 45(11):2193–2201. https://doi.org/10.1111/jog.14104

    CAS  Article  PubMed  Google Scholar 

  6. El-Hennawy A, Abd-Elwahab A, Abd-Elmaksoud A, El-Ozairy H, Boulis S (2009) Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth 103(2):268–274. https://doi.org/10.1093/bja/aep159

    CAS  Article  PubMed  Google Scholar 

  7. Hanoura SE, Hassanin R, Singh R (2013) Intraoperative conditions and quality of postoperative analgesia after adding dexmedetomidine to epidural bupivacaine and fentanyl in elective cesarean section using combined spinal-epidural anesthesia. Anesth Essays Res 7(2):168–172. https://doi.org/10.4103/0259-1162.118947

    Article  PubMed  PubMed Central  Google Scholar 

  8. Imani F, Entezary SR, Alebouyeh MR, Parhizgar S (2011) The maternal and neonatal effects of adding tramadol to 2% lidocaine in epidural anesthesia for cesarean section. Anesth Pain Med 1(1):25–29. https://doi.org/10.5812/aapm.1271

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jun W, Zhengzhuang A, Li O (2018) Analgesic efficacy of dexmedetomidine used for epidural anesthesia on labor analgesia. Biomed Res 29(3):426–430. https://doi.org/10.4066/biomedicalresearch.29-17-2921

    Article  Google Scholar 

  10. Karhade SS, Acharya SA, Harnagale K (2015) Comparative analysis of epidural bupivacaine versus bupivacaine with dexmedetomidine for vaginal hysterectomy. Anesth Essays Res 9(3):310–313

    Article  Google Scholar 

  11. Kaur S, Attri JP, Kaur G, Singh TP (2014) Comparative evaluation of ropivacaine versus dexmedetomidine and ropivacaine in epidural anesthesia in lower limb orthopedic surgeries. Saudi J Anaesth 8(4):463–469. https://doi.org/10.4103/1658-354X.140838

    Article  PubMed  PubMed Central  Google Scholar 

  12. Keskin H, Keskin EA, Avsar A, Tabuk M, Caglar G (2003) Pethidine versus tramadol for pain relief during labor. Int J Gynecol Obstet 82(1):11–16. https://doi.org/10.1016/S0020-7292(03)00047-X

    CAS  Article  Google Scholar 

  13. Knuf KM, Maani CV, Cummings AK (2018) Clinical agreement in the American Society of Anesthesiologists physical status classification. Perioper Med 7(1):1–6. https://doi.org/10.1186/s13741-018-0094-7

    Article  Google Scholar 

  14. Lebovits AH, Zenetos P, O’Neill DK, Cox D, Dubois MY, Jansen LA et al (2001) Satisfaction with epidural and intravenous patient-controlled analgesia. Pain Med 2(4):280–286. https://doi.org/10.1046/j.1526-4637.2001.01051.x

    CAS  Article  PubMed  Google Scholar 

  15. Li F, Wu T, Lei X, Zhang H, Mao M, Zhang J (2013) The Apgar score and infant mortality. PloS one 8(7):e69072. https://doi.org/10.1371/journal.pone.0069072

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. Li G, Xiao Y, Qi X, Wang H, Wang X, Sun J, Li Y, Li Y (2020) Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: a randomized controlled trial. Exp Ther Med 20(1):454–460. https://doi.org/10.3892/etm.2020.8730

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. Mauro V, Brandão S (2004) Clonidine and dexmedetomidine through epidural route for post-operative analgesia and sedation in a colecistectomy. Rev Bras Anestesiol 4:1–10

    Google Scholar 

  18. Mo Y, Qiu S (2017) Effects of dexmedetomidine in reducing post-cesarean adverse reactions. Exper Ther Med 14(3):2036–2039. https://doi.org/10.3892/etm.2017.4759

    CAS  Article  Google Scholar 

  19. Okholm C, Goetze JP, Svendsen LB, Achiam MP (2014) Inflammatory response in laparoscopic vs. open surgery for gastric cancer. Scand J Gastroenterol 49(9):1027–1034. https://doi.org/10.3109/00365521.2014.917698

    CAS  Article  PubMed  Google Scholar 

  20. Qi X, Chen D, Li G, Huang X, Li Y, Wang X, Li Y (2016a) Comparison of intrathecal dexmedetomidine with morphine as adjuvants in cesarean sections. Biol Pharm Bull 39(9):1455–1460. https://doi.org/10.1248/bpb.b16-00145

    CAS  Article  PubMed  Google Scholar 

  21. Qi X, Li Y, Rahe-Meyer N, Huang X, Gu Y, Wang X, Li Y, Wen Y (2016b) Intrathecal dexmedetomidine as adjuvant to ropivacaine in hysteroscopic surgery: a prospective, randomized control study. Int J Clin Pharmcol Ther 54(3):185–192. https://doi.org/10.5414/CP202427

    CAS  Article  Google Scholar 

  22. Rodríguez-Ramón R, Márquez-González H, Jiménez-Báez MV, Iparrea-Ramos IC (2015) Analgesic efficacy of two concentrations of bupivacaine in women in labor: randomized, controlled, triple blind clinical trial. Rev Col Anest 43(3):179–185. https://doi.org/10.1016/j.rca.2015.02.006

    Article  Google Scholar 

  23. Sari S, Sen S, Kurt Omurlu I, Oner Şavk S, Bakiş M (2015) Degree of motor block measured by Bromage scale is not correlated with muscle relaxation. Enliven J Anesthesiol Crit Care Med 2(2):005. https://doi.org/10.18650/2374-4448.22005

    Article  Google Scholar 

  24. Sathyanarayana LA, Heggeri VM, Simha PP, Narasimaiah S, Narasimaiah M, Subbarao BK (2016) Comparison of epidural bupivacaine, levobupivacaine and dexmedetomidine in patients undergoing vascular surgery. J Clin Diagn Res 10(1):UC13–UC17. https://doi.org/10.7860/JCDR/2016/17344.7079

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. Selim MF, Elnabtity AM, Hassan AM (2012) Comparative evaluation of epidural bupivacaine–dexmedetomidine and bupivacaine–fentanyl on Doppler velocimetry of uterine and umbilical arteries during labor. J Prenat Med 6(3):47–54

    PubMed  PubMed Central  Google Scholar 

  26. Shaikh SI, Mahesh SB (2016) The efficacy and safety of epidural dexmedetomidine and clonidine with bupivacaine in patients undergoing lower limb orthopedic surgeries. J Anaesthesiol Clin Pharmacol 32(2):203–209. https://doi.org/10.4103/0970-9185.182104

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  27. Soni P (2016) Comparative study for better adjuvant with ropivacaine in epidural anesthesia. Anesth Essays Res 10(2):218–222. https://doi.org/10.4103/0259-1162.174470

    Article  PubMed  PubMed Central  Google Scholar 

  28. Voutilainen A, Pitkäaho T, Kvist T, Vehviläinen-Julkunen K (2016) How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale. J Adv Nurs 72(4):946–957. https://doi.org/10.1111/jan.12875

    Article  PubMed  Google Scholar 

  29. Wang Y, Xu M (2020) Comparison of ropivacaine combined with sufentanil for epidural anesthesia and spinal-epidural anesthesia in labor analgesia. BMC Anesthesiol 20(1):1–5. https://doi.org/10.1186/s12871-019-0855-y

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. Wangping Z, Ming R (2017) Optimal dose of epidural dexmedetomidine added to ropivacaine for epidural labor analgesia: a pilot study. Evid Based Complement Alternat Med 2017:7924148. https://doi.org/10.1155/2017/7924148

    Article  PubMed  PubMed Central  Google Scholar 

  31. Whitburn LY, Jones LE, Davey M-A, McDonald S (2019) The nature of labour pain: an updated review of the literature. Women Birth 32(1):28–38. https://doi.org/10.1016/j.wombi.2018.03.004

    Article  PubMed  Google Scholar 

  32. Yang Y, Song C, Song C, Li C (2020) Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section. Exp Ther Med 19(3):1747–1754. https://doi.org/10.3892/etm.2020.8429

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  33. Yoshitomi T, Kohjitani A, Maeda S, Higuchi H, Shimada M, Miyawaki T (2008) Dexmedetomidine enhances the local anesthetic action of lidocaine via an α-2A adrenoceptor. Anesth Analg 107(1):96–101. https://doi.org/10.1213/ane.0b013e318176be73

    CAS  Article  PubMed  Google Scholar 

  34. Yousef AA, Salem HA, Moustafa MZ (2015) Effect of mini-dose epidural dexmedetomidine in elective cesarean section using combined spinal–epidural anesthesia: a randomized double-blinded controlled study. J Anesth 29(5):708–714. https://doi.org/10.1007/s00540-015-2027-7

    Article  PubMed  Google Scholar 

  35. Zhang T, Yu Y, Zhang W, Zhu J (2019) Comparison of dexmedetomidine and sufentanil as adjuvants to local anesthetic for epidural labor analgesia: a randomized controlled trial. Drug Des Devel Ther 13:1171–1175. https://doi.org/10.2147/DDDT.S197431

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  36. Zhang X, Wang D, Shi M, Luo Y (2017) Efficacy and safety of dexmedetomidine as an adjuvant in epidural analgesia and anesthesia: a systematic review and meta-analysis of randomized controlled trials. Clin Drug Investig 37(4):343–354. https://doi.org/10.1007/s40261-016-0477-9

    CAS  Article  PubMed  Google Scholar 

  37. Zhao Y, Xin Y, Liu Y, Yi X, Liu Y (2017) Effect of epidural dexmedetomidine combined with ropivacaine in labor analgesia. Clin J Pain 33(4):319–324. https://doi.org/10.1097/AJP.0000000000000411

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

None.

Author information

Affiliations

Authors

Contributions

MEA contributed in the idea and the design of work. RFM and MMAA contributed to the literature search, analysis, and interpretation of data. RFM and MEA contributed in the manuscript preparation, editing, and review. HL contributed in the follow-up of the progress of labor, fetal monitoring, delivery of the fetus, and collecting the data for interpretation. All the authors have read and approved the final submitted manuscript.

Corresponding author

Correspondence to Radwa Fathy Mansour.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Local Ethical Committee of Tanta University (approval number 31725/08/17) and Pan African Clinical Trial Registration (PACTR201710002664704). A written informed consent was obtained from the participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Afandy, M.E., Abusabaa, M.M.A., Lotfy, H.A. et al. Effect of the use of dexmedetomidine as a local anesthetic adjuvant to bupivacaine 0.125% in epidural labor analgesia: randomized controlled study. Ain-Shams J Anesthesiol 13, 76 (2021). https://doi.org/10.1186/s42077-021-00196-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s42077-021-00196-w

Keywords

  • Epidural analgesia
  • Dexmedetomidine
  • Normal delivery