Intrathecal Bupivacaine – Dexmedetomidine Compared to Intrathecal Bupivacaine - Neostigmine in Elective Caesarian Section: A Randomized Controlled Trial

Background: Caesarean section (CS) is a common surgical procedure associated with moderate-to-severe postoperative pain, which can hinder recovery Objectives: To evaluate the effects of adding neostigmine versus dexmedetomidine (DEX) to intrathecal hyperbaric bupivacaine 0.5% in CS Patients and methods: A double-blind, randomized controlled trial was conducted on 54 parturients, aged 18 to 40 years, with a height range of 150 to 170 cm and a weight range of 70 to 110 kg, classified as ASA II, scheduled for elective CS under spinal anesthesia. Participants were randomly assigned to three equal groups. Patients received: 2 mL hyperbaric bupivacaine 0.5% plus 0.1 mL (10 µg) dexmedetomidine (DEX) and 0.1 mL saline 0.9% in group1 (D group).0.1mL (50 µg) neostigmine and 0.1 mL saline 0.9% in group2 (N group). 0.2 mL saline 0.9% in group3 (C group; control) Results: The time to achieve Bromage 3 (D: 4.1 ± 2.1 min, N: 5.9 ± 2.1 min, C: 8.3 ± 2 min) (p < 0.001), time to reach T10 (D: 5.2 ± 2.1 min, N: 7 ± 1.7 min, C: 9.1 ± 1.9 min) (p < 0.001), time to reach T4 (D: 7.3 ± 1.7 min, N: 8.9 ± 1.7 min, C: 11.2 ± 2 min) (p < 0.001), and time to attain the maximum sensory level (D: 10.2 ± 1.9 min, N: 11.9 ± 1.8 min, C: 14.5 ± 2.2 min) (p < 0.001) were significantly shorter in the DEX group than in the neostigmine and control groups. The neostigmine group also showed a significant reduction compared to the control group. The regression times for sensory (D: 10.3 ± 1.5 min, N: 6.4 ± 1.8 min, C: 4.3 ± 0.7 min) (p < 0.001) and motor block (D: 8.9 ± 1.4 min, N: 5.1 ± 1.7 min, C: 2.8 ± 0.9 min) (p < 0.001) were significantly prolonged in the DEX group compared to the neostigmine and control groups. Additionally, the neostigmine group exhibited a longer regression time than the control group. Conclusion: Dexmedetomidine provides more effective sensory and motor blockade characteristics than neostigmine when added to intrathecal bupivacaine during CS.