IMPACT OF DEXMEDETOMIDINE USE AS AN ADJUVANT ANESTHETIC IN CESAREAN SECTION UNDER SPINAL ANESTHESIA: A SYSTEMATIC REVIEW

Introduction: Cesarean section under spinal anesthesia is widely practiced due to its favorable maternal and neonatal safety profile, yet intraoperative discomfort, shivering, hemodynamic instability, and limited postoperative analgesia remain relevant clinical challenges. Dexmedetomidine, a highly selective alpha-2 adrenergic agonist, has been increasingly investigated as an intrathecal or intravenous adjuvant to spinal anesthesia in obstetric practice. Its sedative, analgesic, and sympatholytic properties suggest potential benefits in improving anesthetic quality while preserving maternal cooperation and neonatal well-being. Objective: The main objective of this systematic review was to evaluate the impact of dexmedetomidine as an adjuvant to spinal anesthesia in cesarean section on maternal anesthetic outcomes and safety. Secondary objectives included assessing its effects on intraoperative sedation quality, hemodynamic stability, postoperative analgesia, incidence of adverse effects, and neonatal outcomes. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform. Randomized and non-randomized studies published within the last five years evaluating dexmedetomidine as an adjuvant to spinal anesthesia for cesarean section were included. Data were synthesized qualitatively, focusing on anesthetic efficacy, safety outcomes, and neonatal parameters. Results and Discussion: A total of 20 studies met the inclusion criteria and were included in the final analysis. Most studies demonstrated that dexmedetomidine, administered either intrathecally or intravenously, was associated with improved intraoperative sedation, prolonged sensory and motor block duration, reduced postoperative analgesic requirements, and lower incidence of shivering. Hemodynamic effects were generally mild and manageable, and neonatal outcomes, including Apgar scores and umbilical cord blood parameters, were comparable to control groups. Conclusion: Current evidence suggests that dexmedetomidine is a promising and safe adjuvant to spinal anesthesia in cesarean section, offering improved anesthetic quality and maternal comfort without compromising neonatal safety when used at appropriate doses.