<p>Impact of Intraoperative Infusion and Postoperative PCIA of Dexmedetomidine on Early Breastfeeding After Elective Cesarean Section: A Randomized Double-Blind Controlled Trial</p>

Abstract

Objective: Few studies have investigated the effects of dexmedetomidine (DEX) on breastfeeding after cesarean delivery. A randomized double-blind controlled trial was conducted to investigate whether the administration of DEX, immediately after delivery and for patient-controlled intravenous analgesia (PCIA), can be beneficial for breastfeeding. Patients and Methods: One hundred sixty parturients scheduled for elective cesarean section under spinal anesthesia were randomly allocated to the DEX group (a loading dose of DEX was pumped at 0.5 μg/kg within 10 min, followed by a further infusion of DEX at 0.5 μg/kg/h until the end of the surgery and PCIA for 2 days with DEX plus sufentanil) or the standard care group (infusion saline intraoperatively, and PCIA for 2 days with sufentanil). The number of days required to switch to exclusive breastfeeding within six weeks of delivery, the time to first lactation and breast milk volume on day 1 and day 2 after delivery were recorded. Recovery quality, comfort, anxiety, depression, postoperative analgesia, and adverse reactions of parturients were also assessed. Results: Compared with the standard care group, parturients in the DEX group could be converted to exclusive breastfeeding earlier (11 [14] vs 8 [10] days, log-rank P=0.025), the first lactation time was sooner (28.38 [13.82] vs 33.79 [14.85] hrs, P=0.024), and the amount of breast milk on the second day after delivery increased (P=0.012). There was no difference between the two groups in postpartum uterine contraction pain, but postpartum rest and movement VAS scores and recovery quality score in the DEX group were better than those in the standard care group (all P<0.05). Moreover, the hospital anxiety and depression scale and anxiety subscale score on the second day after delivery and the comfort score on the third day after delivery in the DEX group were significantly better than those in the standard care group (5 [5] vs 6 [8], 2 [2] vs 3 [3], 83.58 [6.75] vs 80.48 [6.58]; P=0.013, P=0.005, P=0.006, respectively). The incidence of adverse events, such as bradycardia, vomiting, hypersomnia, hypertension and hypotension, was not significantly different between the DEX and standard care groups (6.9% vs 2.7%, 5.6% vs 13.7%, 4.2% vs 0%, 5.6% vs 2. 7%, 11.1% vs 8.2%; P=0.275, P=0.158, P=0.366, P=0.681, P=0.556, respectively), except more parturients experienced nausea in the standard care group than in the DEX group (28.8% vs 11.1%, P=0.012). Furthermore, there was no difference in Neonatal Behavioral Neurological Assessment scores on the first and second days after delivery between the DEX and standard care groups (38 [3] vs 37 [2], 38.5 [2] vs 38 [2]; P=0.173, P=0.312, respectively). Conclusion: The application of DEX in the perioperative period of cesarean section was not only conducive to the early conversion of infant feeding to exclusive breastfeeding but could also improve the recovery quality and comfort of the parturient, optimize analgesia, shorten the time to first lactation, and increase lactation.

Retrospective Comparison of the Safety and Effectiveness of Dexmedetomidine Versus Standard of Care Before and During Cesarean Delivery in a Maternity Unit in Zhengzhou, China

“…Bupivacaine 0.5% (Marcaine, Hospira, Inc., Lake Forest, Illinois, U.S.A.) then was administered at 0.1 mL/s for 1 to 2 min. to maintain sensory block plane at the T4/T6 level [ 2 ]. The anesthesia was administered by anesthesiologists with a minimum of 3 years of experience.…”

“…Data are shown as a frequency (percentage) and continuous and ordinal data as mean±SD. One-way analysis of variance (ANOVA) [ 2 ] was performed on continuous data and Fisher’s exact test [ 7 ] was performed on constant and ordinal data. Tukey’s test (with a critical value q>3.326) was performed for post hoc analysis.…”

“…Tukey’s test (with a critical value q>3.326) was performed for post hoc analysis. The sample size was calculated on the basis of 80% power and a 5% margin of error [ 2 ]. All results were considered significant at a 95% confidence level.…”

“…Cesarean deliveries are common [ 1 ] and post-delivery pain [ 2 ], anxiety, and depression [ 3 ] are seen more often in women who deliver via cesareans than vaginally. Effective post-delivery pain relief affects the recovery of women after cesarean delivery [ 4 ].…”

“…However, when combined with sufentanil, dexmedetomidine results in excessive sedation [ 7 ], and adverse effects include hypotension [ 5 ] and bradycardia [ 7 ]. The maternal and fetal effects of administering dexmedetomidine after delivery have not been thoroughly evaluated [ 2 ]. Stronger evidence is required about the drug’s analgesic and sedative actions in obstetric settings.…”