Background: Effective postoperative analgesia is pivotal for enhanced maternal recovery following elective Lower-Segment Caesarean Section (LSCS). Although spinal anaesthesia is the preferred technique due to rapid onset, dense blockade and maternal safety, the limited duration of analgesia necessitates early administration of rescue analgesics. Intrathecal morphine remains a standard opioid adjuvant but is associated with adverse effects such as nausea, pruritus and respiratory depression. Dexmedetomidine, a highly selective ?2-adrenergic agonist, is an emerging non-opioid adjuvant that enhances sensory and motor blockade with minimal side effects. This study compares the efficacy and safety profile of levobupivacaine combined with dexmedetomidine versus morphine in parturients undergoing elective LSCS.
Methods: A prospective, randomized, double-blinded clinical study was conducted at Naruvi Hospitals, Vellore, involving 80 ASA I-II parturients undergoing elective LSCS. Participants were randomly assigned to two equal groups: Group A received 1.8-2.2 ml of 0.5% hyperbaric levobupivacaine + 100 ?g morphine; Group B received 1.8-2.2 ml of 0.5% hyperbaric levobupivacaine + 3 ?g dexmedetomidine. Postoperative monitoring was performed for 24 hours, recording analgesic duration, pain scores, the incidence of postoperative nausea and vomiting (PONV), pruritus, shivering, sedation, hemodynamic fluctuations and neonatal Apgar scores. Rescue analgesia (IV tramadol) was administered only when NPRS > 3.
Results: Both groups demonstrated comparable maternal hemodynamics and stable neonatal outcomes (Apgar scores at 1 min and 5 min showed no statistical difference). Pain remained minimal in both groups across 24 hours, with dexmedetomidine showing a mild advantage at 16 hours (mean NPRS 1.50 vs. 1.78; p = 0.04). No patient required postoperative rescue analgesia in either group. Incidence of pruritus, PONV and shivering was negligible; sedation scores remained optimal and uniform in both groups.
Conclusion: Intrathecal dexmedetomidine (3 ?g) and morphine (100 ?g) provided equally effective 24-hour postoperative analgesia when combined with hyperbaric levobupivacaine in LSCS, with dexmedetomidine offering a slight edge in prolongation of analgesia and avoidance of opioid-related adverse effects. Both are safe, well-tolerated and clinically viable options based on maternal and institutional preferences.
International Journal of Clinical Obstetrics and Gynaecology
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