Effect of intraoperative intravenous infusion of dexmedetomidine on postoperative ileus in parturients undergoing cesarean section with combined spinal-epidural anesthesia: a single center, prospective, double blind, randomized controlled trial.

objectiveTo evaluate the effect of intraoperative intravenous dexmedetomidine on postoperative ileus in parturients with a previous cesarean scar undergoing elective cesarean delivery under combined spinal-epidural anesthesia.

methodsIn this prospective, double-blind trial, 78 parturients (ASA physical status II, aged 18-45 years) scheduled for elective cesarean section with a history of lower-segment cesarean section were randomly assigned to receive either dexmedetomidine (n = 39) or normal saline (n = 39). Following umbilical cord clamping, the dexmedetomidine group received a loading dose of 1 µg·kg⁻¹ over 10 min, followed by a maintenance infusion of 0.5 µg·kg⁻¹·h⁻¹ until the end of surgery. The control group received an equivalent volume of saline at the same infusion rate. The primary outcome was time to first flatus. Secondary outcomes included time to first defecation, incidence of abdominal distension, postoperative nausea and vomiting (PONV), the requirement for rescue analgesia within 24 h, and length of hospital stay.

resultsBaseline characteristics were comparable between groups (all P > 0.05). Compared with the control group, the dexmedetomidine group demonstrated significantly shorter times to first flatus (23.5 ± 6.8 h vs. 32.1 ± 8.7 h; P < 0.001) and first defecation (41.5 ± 8.3 h vs. 57.5 ± 16.8 h; P < 0.001), as well as a lower incidence of abdominal distension (10.3% vs. 32.4%; P < 0.05). In addition, the dexmedetomidine group had lower incidence of PONV at 24 h (7.7% vs. 32.4%; P = 0.007) and required less rescue analgesia within 24 h (10.3% vs. 29.7%; P = 0.033). The requirement for intraoperative atropine for bradycardia was significantly higher in the dexmedetomidine group (28.2% vs. 8.1%; P = 0.024).

conclusionIntraoperative intravenous dexmedetomidine significantly accelerates postoperative gastrointestinal recovery, reduces the incidence of postoperative ileus and related adverse events, and shortens hospital stay in parturients undergoing cesarean delivery under combined spinal-epidural anesthesia.

trial registrationThe trial was prospectively registered in the Chinese Clinical Trial Registry (ChiCTR) prior to patient enrollment (registration number: ChiCTR2300068136, date of registration: February 8, 2023; URL: https://www.chictr.org.cn/showproj.html?proj=185474 ).