Objective To evaluate the clinical efficacy and safety of dexmedetomidine as an adjuvant to bupivacaine versus bupivacaine alone during cesarean section, in terms of anesthetic effect, analgesia level, and fetal‑related outcomes.

Methods PubMed, Embase, and the Cochrane Library were electronically searched for randomized controlled trials (RCTs) relevant to the study objective from inception to October 9, 2025. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta‑analysis was performed using R software (version 4.5.1).

Results A total of 18 RCTs involving 1,277 patients were included. Meta-analysis results showed that, compared with the bupivacaine group, the bupivacaine plus dexmedetomidine group significantly shortened the sensory block time [MD=-1.09, 95%CI (-1.73, -0.46)], the motor block time [MD=-1.11, 95%CI(-1.90, -0.31)], the motor block recovery time [MD=-65.14, 95%CI(-94.51, -35.77)]. It also prolonged the sensory block recovery time [MD=73.83, 95%CI (45.04, 102.63)]. Bupivacaine plus dexmedetomidine significantly reduced visual analogue scale pain scores at 1, 2, 4, and 8 h postoperatively compared with bupivacaine alone (P<0.05). In terms of safety, the incidence of pruritus events in the bupivacaine plus dexmedetomidine group was significantly lower than that in the bupivacaine group [RR=0.41, 95%CI (0.30, 0.57)]. However, there were no statistically significant differences in umbilical artery pH, 1-minute APGAR score, or 5-minute APGAR score among neonatal outcomes between the two groups.

Conclusion Compared to bupivacaine alone, intrathecal administration of bupivacaine combined with dexmedetomidine in cesarean spinal anesthesia provides better analgesia effect and sedation within 12 h postoperatively, along with favorable safety profile.

1. WHO. WHO publishes surgical sub-group membership for caesarean section recommendations[EB/OL]. (2025-05-13) [2026-07-29]. https://www.who.int/news/item/13-05-2025-who-publi shes-surgical-sub-group-membership-for-caesarean-section-reco mmendations.

2. JuangJ, GabrielRA, DuttonRP, et al. Choice of anesthesia for cesarean delivery: an analysis of the national anesthesia clinical outcomes registry[J]. Anesth Analg, 2017, 124(6): 1914-1917. DOI: 10.1213/ane.0000000000001677.

3. CocchiE, PiniR, GallipoliA, et al. Impact of general vs. neuraxial anesthesia on neonatal outcomes in non-elective cesarean sections[J]. Front Pediatr, 2025, 13: 1518456. DOI: 10.3389/fped.2025.1518456.

4. KearnsRJ, ShawM, GromskiPS, et al. Neonatal and early childhood outcomes following maternal anesthesia for cesarean section: a population-based cohort study[J]. Reg Anesth Pain Med, 2021, 46(6): 482-489. DOI: 10.1136/rapm-2020-102441.

5. WatsonSE, RichardsonAL, LucasDN. Neuraxial and general anaesthesia for caesarean section[J]. Best Pract Res Clin Anaesthesiol, 2022, 36(1): 53-68. DOI: 10.1016/j.bpa.2022.04.007.

6. FerrareziWPP, BragaAFA, FerreiraVB, et al. Spinal anesthesia for elective cesarean section. Bupivacaine associated with different doses of fentanyl: randomized clinical trial[J]. Braz J Anesthesiol, 2021, 71(6): 642-648. DOI: 10.1016/j.bjane.2021.03.030.

7. OlapourA, AkhondzadehR, RashidiM, et al. Comparing the effect of bupivacaine and ropivacaine in cesarean delivery with spinal anesthesia[J]. Anesth Pain Med, 2020, 10(1): e94155. DOI: 10.5812/aapm.94155.

8. DerakhshanP, ImaniF, KoleiniZS, et al. Comparison of adding sufentanil and low-dose epinephrine to bupivacaine in spinal anesthesia: a randomized, double-blind, clinical trial[J]. Anesth Pain Med, 2018, 8(5): e69600. DOI: 10.5812/aapm.69600.

9. PatelR, KuaJ, SharawiN, et al. Inadequate neuraxial anaesthesia in patients undergoing elective caesarean section: a systematic review[J]. Anaesthesia, 2022, 77(5): 598-604. DOI: 10.1111/anae.15657.

10. NguyenV, TiemannD, ParkE, et al. Alpha-2 agonists[J]. Anesthesiol Clin, 2017, 35(2): 233-245. DOI: 10.1016/j.anclin.2017.01.009.

11. ShenQH, LiHF, ZhouXY, et al. Dexmedetomidine as an adjuvant for single spinal anesthesia in patients undergoing cesarean section: a system review and Meta-analysis[J]. J Int Med Res, 2020, 48(5): 300060520913423. DOI: 10.1177/0300060520913423.

12. LiuM, ChenX, GuoD. Effect of epidural dexmedetomidine in single-dose combined with ropivacaine for cesarean section[J]. BMC Anesthesiol, 2024, 24(1): 134. DOI: 10.1186/s12871-024-02519-4.

13. PonthusS, SpahrL, CasiniA, et al. Safety of variceal band ligation in patients with cirrhosis and portal vein thrombosis treated with anticoagulant therapy: A retrospective study[J]. Eur J Gastroenterol Hepatol, 2020, 32(3): 395-400. DOI: 10.1097/meg.0000000000001522.

14. SterneJAC, SavovićJ, PageMJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials[J]. BMJ, 2019, 366: l4898. DOI: 10.1136/bmj.l4898.

15. libraryC. Cochrane Handbook: Chapter 10: Analysing data and undertaking meta-analyses[EB/OL]. 2023. https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-10.

16. HospiraI. MARCAINE® SPINAL (bupivacaine hydrochloride in dextrose injection): Highlights of prescribing information[EB/OL]. 2022. https://www.fda.gov/drugsatfda.

17. AbbasSE, QayyumA, QamarK, et al. Comparison of bupivacaine with and without dexmedetomidine on duration of analgesia among patients undergoing cesarean section under spinal anesthesia: bupivacaine and dexmedetomidine: cesarean section under spinal anesthesia[J]. Pakistan Journal of Health Sciences, 2025, 253-257.

18. AzematiS, ZarghamiA, JouybarR, et al. Analgesic characteristics of bupivacaine alone and in combination with dexmedetomidine or meperidine in spinal anesthesia during cesarean section: a double-blind randomized clinical trial study[J]. Pain Res Manag, 2022, 2022: 5111214. DOI: 10.1155/2022/5111214.

19. BiYH, CuiXG, ZhangRQ, et al. Low dose of dexmedetomidine as an adjuvant to bupivacaine in cesarean surgery provides better intraoperative somato-visceral sensory block characteristics and postoperative analgesia[J]. Oncotarget, 2017, 8(38): 63587-63595. DOI: 10.18632/oncotarget.18864.

20. ElgebalyA. Evaluation the effects of intravenous vs. spinal dexmedetomidine during anesthesia for cesarean sections with severe pre-eclampsia[J]. J Anesth Clin Res, 2018, 9(1): 1-6. DOI: 10.4172/2155-6148.1000801.

21. FarooqS, RizviMFA, YousufSMA, et al. Comparing intrathecal dexmedetomidine and fentanyl as adjuvants to hyperbaric bupivacaine in elective casarian section, a study[J]. Professional Med J, 2022, 29(2): 218-226. DOI: 10.29309/TPMJ/2022.29.02.6414.

22. Hamed Hassan SaafanAF, AhmedEl-Hossary ZI, EbraheemHE. Effect of dexamethasone versus dexmedetomidine as an adjuvant to intrathecal hyperbaric bupivacaine on sensory block and postoperative analgesia in elective ceserean section[J]. ZUMJ, 2025, 31(4): 1480. DOI: 10.21608/zumj.2025.356985.3822.

23. HeL, XuJM, LiuSM, et al. Intrathecal dexmedetomidine alleviates shivering during cesarean delivery under spinal anesthesia[J]. Biol Pharm Bull, 2017, 40(2): 169-173. DOI: 10.1248/bpb.b16-00651.

24. LiXX, LiYM, LvXL, et al. The efficacy and safety of intrathecal dexmedetomidine for parturients undergoing cesarean section: a double-blind randomized controlled trial[J]. BMC Anesthesiol, 2020, 20(1): 190. DOI: 10.1186/s12871-020-01109-4.

25. LiZ, TianM, ZhangCY, et al. A randomised controlled trial to evaluate the effectiveness of intrathecal bupivacaine combined with different adjuvants (fentanyl, clonidine and dexmedetomidine) in caesarean section[J]. Drug Res (Stuttg), 2015, 65(11): 581-586. DOI: 10.1055/s-0034-1395614.

26. MagdyH, MohsenM, SalehM. The effect of intrathecal compared with intravenous dexmedetomidine as an adjuvant to spinal bupivacaine anesthesia for cesarean section[J]. Ain Shams Journal of Anesthesiology, 2015, 8(1). DOI: 10.4103/1687-7934.153949.

27. MahdyWR, AbdullahSI. Effect of adding dexmedetomidine versus fentanyl to intrathecal bupivacaine on spinal block characteristics and neonatal outcome in uncomplicated cesarean delivery: a randomized double blind placebo controlled study[J]. Menoufiya Med J, 2011, 24(1): 221-231.

28. MostafaMF, HerdanR, FathyGM, et al. Intrathecal dexmedetomidine versus magnesium sulphate for postoperative analgesia and stress response after caesarean delivery; randomized controlled double-blind study[J]. Eur J Pain, 2020, 24(1): 182-191. DOI: 10.1002/ejp.1476.

29. QiX, ChenD, LiG, et al. Comparison of intrathecal dexmedetomidine with morphine as adjuvants in cesarean sections[J]. Biol Pharm Bull, 2016, 39(9): 1455-1460. DOI: 10.1248/bpb.b16-00145.

30. QureshiRA, JadoonH, ShabbirM. Comparative evaluation of intrathecal hyperbaric bupivacaine alone versus combined with dexmedetomidine for cesarean sections[J]. Anaesthesia, Pain & Intensive Care, 2024, 28(5): 866-870. DOI: 10.35975/apic.v28i5.2558.

31. QureshiSA, QurbanF, IlyasMU. Comparison between dexmedetomidine plus bupivacaine and simple bupivacaine for post-operative pain relief among pregnant women undergoing cesarean section under spinal[J]. Med Forum Mon, 2025, 36(1): 47-51. DOI: 10.60110/medforum.360110.

32. SunY, XuY, WangGN. Comparative evaluation of intrathecal bupivacaine alone, bupivacaine-fentanyl, and bupivacaine-dexmedetomidine in caesarean section[J]. Drug Res (Stuttg), 2015, 65(9): 468-472. DOI: 10.1055/s-0034-1387740.

33. SushruthM, RaoDG. Effect of adding intrathecal dexmedetomidine as an adjuvant to hyperbaric bupivacaine for elective cesarean section[J]. Anaesth, Pain Intensive Care, 2018, 22(3): 348-354.

34. XiaF, ChangX, ZhangY, et al. The effect of intrathecal dexmedetomidine on the dose requirement of hyperbaric bupivacaine in spinal anaesthesia for caesarean section: a prospective, double-blinded, randomized study[J]. BMC Anesthesiol, 2018, 18(1): 74. DOI: 10.1186/s12871-018-0528-2.

35. AoL, ShiJ, BaiY, et al. Effectiveness and safety of intravenous application of dexmedetomidine for cesarean section under general anesthesia: a Meta-analysis of randomized trials[J]. Drug Des Devel Ther, 2019, 13: 965-974. DOI: 10.2147/DDDT.S197165.

36. PangG, ZhuY, ZhouY, et al. The anesthetic effect and safety of dexmedetomidine in cesarean section: a meta-analysis[J]. Biomed Res Int, 2022, 2022: 1681803. DOI: 10.1155/2022/1681803.

37. HalaszynskiTM. Dexmedetomidine: A look at a promising new avenue of use[J]. Saudi J Anaesth, 2012, 6(2): 104-106. DOI: 10.4103/1658-354X.97019.

38. MashakB, PouryaghobiSM, HashemnejadM, et al. The duration of spinal anaesthesia in elective caesarean section in Trendelenburg and reverse Trendelenburg positions: a randomized clinical trial[J]. Ann Med Surg (Lond), 2024, 86(5): 2708-2714. DOI: 10.1097/MS9.0000000000001821.

39. SwansonK, LiangL, GrobmanWA, et al. Duration of exposure to general endotracheal anesthesia during cesarean deliveries at term and perinatal complications[J]. Am J Perinatol, 2022, 39(3): 232-237. DOI: 10.1055/s-0041-1739355.

40. ParamasivanA, Lopez‐OlivoMA, FoongTW, et al. Intrathecal dexmedetomidine and postoperative pain: A systematic review and Meta‐analysis of randomized controlled trials[J]. Eur J Pain, 2020, 24(7): 1215-1227. DOI: 10.1002/ejp.1575.

41. MaconesGA, CaugheyAB, WoodSL, et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3)[J]. Am J Obstet Gynecol, 2019, 221(3): 247. e241-247. e249. DOI: 10.1016/j.ajog.2019.04.012.

42. TadesseMA, AlemuEA, AlleneMD, et al. Efficacy and safety of midazolam compared to fentanyl as adjuvants to hyperbaric bupivacaine in spinal anesthesia: a systematic review and Meta-analysis of randomized controlled trials[J]. BMC Anesthesiol, 2025, 25(1): 397. DOI: 10.1186/s12871-025-03261-1.

43. AsgharHF, BashirM, SabirS, et al. Comparison of the effectiveness of tramadol and dexmedetomidine as adjuvants in spinal anesthesia for prolonging postoperative analgesia in patients undergoing hysterectomy (TAH & Vaginal Hysterectomy): tramadol and dexmedetomidine for prolonging postoperative analgesia in hysterectomy[J]. Pakistan Journal of Health Sciences, 2025, 136-141. DOI: 10.54393/pjhs.v6i11.3549.

44. RahimiM, SalmanHA, ShamsiA, et al. Dexamethasone versus fentanyl as adjuvants to intrathecal bupivacaine anesthesia in cesarean section: impacts on analgesia duration and postoperative outcomes[J]. Al-Rafidain J Med Sci, 2025, 9(2): 16-21. DOI: 10.54133/ajms.v9i2.2350.

45. KumarR, SuhailF, SethiC, et al. Comparative evaluation of intrathecal dexmedetomidine and fentanyl as adjuvant to bupivacaine for lower abdominal surgery[J]. International Journal of Scientific Study, 2016, 4(8): 126-129.

46. GautamB, NiroulaS, SharmaM, et al. Effects of intrathecal dexmedetomidine as an adjuvant to hyperbaric bupivacaine for spinal anaesthesia in adults undergoing elective infra-umbilical surgery[J]. JNMA J Nepal Med Assoc, 2017, 56(208): 379-387. DOI: 10.31729/jnma.3394.

47. AhmedSA, LotfyHA, MostafaTAH. The effect of adding dexmedetomidine or dexamethasone to bupivacaine-fentanyl mixture in spinal anesthesia for cesarean section[J]. J Anaesthesiol Clin Pharmacol, 2024, 40(1): 82-89. DOI: 10.4103/joacp.joacp_396_22.

48. ZhangC, LiC, PirroneM, et al. Comparison of dexmedetomidine and clonidine as adjuvants to local anesthetics for intrathecal anesthesia: a meta‐analysis of randomized controlled trials[J]. J Clin Pharmacol, 2016, 56(7): 827-834. DOI: 10.1002/jcph.666.

49. ShokriM, BakhtiariZ, KargarB, et al. The effect of intravenousdexmedetomidine during surgery in the prevention of shivering after general anesthesia in patients undergoing spinal surgery: a randomized clinical trial[J]. Anesth Pain Med, 2025, 15(2): e159077. DOI: 10.5812/aapm-159077.

50. KayeAD, ChernobylskyDJ, ThakurP, et al. Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) protocols for postoperative pain[J]. Curr Pain Headache Rep, 2020, 24(5): 21. DOI: 10.1007/s11916-020-00853-z.

51. ZhangW, WangR, LiB, et al. The effect of dexmedetomidine on postoperative nausea and vomiting in patients undergoing thoracic surgery-A Meta-Analysis of a randomized controlled trial[J]. Front Surg, 2022, 9: 863249. DOI: 10.3389/fsurg.2022.863249.

52. GurbetA, Basagan-MogolE, TurkerG, et al. Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements[J]. Can J Anaesth, 2006, 53: 646-652. DOI: 10.1007/BF03021622.

53. WhittingtonRA, VirágL. Dexmedetomidine-induced decreases in accumbal dopamine in the rat are partly mediated via the locus coeruleus[J]. Anesth Analg. 2006, 102(2): 448-455. DOI: 10.1213/01.ane.0000195234.07413.5a.

54. WatchaMF, WhitePF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention[J]. Anesthesiology, 1992,77(1): 162-184. DOI: 10.1097/00000542-199207000-00023.

55. VozzoP, ZilberS, LandauR. Intrathecal dexmedetomidine for cesarean delivery: a scoping review[J]. Int J Obstet Anesth, 2025, 64: 104738. DOI: 10.1016/j.ijoa.2025.104738.

56. WangC, LiuS, HanC, et al. Effect and placental transfer of dexmedetomidine during caesarean section under epidural anaesthesia[J]. J Int Med Res, 2017, 45(3): 964-972. DOI: 10.1177/0300060517698330.

57. YuM, HanC, JiangX, et al. Effect and placental transfer of dexmedetomidine during caesarean section under general anaesthesia[J]. Basic Clin Pharmacol Toxicol, 2015, 117(3): 204-208. DOI: 10.1111/bcpt.12389.

58. DaillandP, CockshottID, LirzinJD, et al. Intravenous propofol during cesarean section: placental transfer, concentrations in breast milk, and neonatal effects. A preliminary study[J]. Anesthesiology, 1989, 71(6): 827-834. DOI: 10.1097/00000542-198912000-00003.

59. KanRE, HughesSC, RosenMA, et al. Intravenous remifentanil: placental transfer, maternal and neonatal effects[J]. Anesthesiology, 1998, 88(6): 1467-1474. DOI: 10.1097/00000542-199806000-00008.