Date of Award

2025

Degree Name

Management Practice in Nurse Anesthesia

College

College of Business

Type of Degree

D.N.A.P.

Document Type

Research Paper

First Advisor

Megan E. Workman, DMP, APRN, CRNA

Second Advisor

Alberto Coustasse, Dr.PH. MD, MBA, MPH

Abstract

Problem Statement: Cesarean delivery is associated with significant postoperative pain, typically managed with spinal anesthesia using a local anesthetic. While opioids are often added as adjuncts, the addition of dexmedetomidine, an alpha-2 agonist, has emerged as a potential alternative that may enhance the efficacy of the spinal block in terms of pain management, potentially improving block duration and quality compared to local anesthetic alone.

Methodology: A literature review was conducted on the use of dexmedetomidine as an adjunct to spinal anesthesia for patients undergoing cesarean sections. Databases used for the search included PubMed, CINAHL Complete, and MEDLINE. The keywords used to search databases included: “intrathecal” or “spinal”, “dexmedetomidine”, “cesarean section”, and “duration”. Inclusion criteria were set for cesarean sections. Exclusion criteria were set for non-cesarean sections. Year limits were set for the period from 2015 to 2025. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used as the method for decision-making regarding article inclusion in this review.

Results : A total of 145 articles were initially identified through database searches using the specified search terms. After applying exclusion criteria, 130 articles were eliminated, leaving 15 for further review. Four articles were then excluded after abstract screening due to a lack of relevance. Three more articles were removed as duplicates. The article selection process adhered to PRISMA guidelines (Page et al., 2021) and is illustrated in Figure 1. Few studies specifically examined the intrathecal addition of dexmedetomidine, compared to local anesthetic alone, as an alternative to opioid-based adjuncts. A total of eight peer-reviewed articles met the criteria and were included in the final analysis. These studies evaluated the duration of spinal block for parturients undergoing cesarean sections. Table 1 provides a summary of the studies included in this project, along with their key findings. Although several articles reported outcomes beyond the scope of this project, only relevant data were extracted and analyzed for this study.

Subject(s)

Health services administration.

Health facilities -- Business management.

Childbirth -- Hospital care.

Anesthesia.

Anesthesiology.

Obstetrics.

Pain -- Treatment.

Postoperative care.

Cesarean section.

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