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Background <p>Cesarean Delivery (CD) often causes moderate to severe postoperative pain. The transversus abdominis plane (TAP) block reduces somatic pain after lower abdominal surgeries; however, its duration is limited when local anesthetics are used alone. Adjuvants like dexmedetomidine and dexamethasone are used to prolong analgesia, but their comparative efficacy in TAP block for CD remains uncertain.</p> Methods <p>We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing dexmedetomidine and dexamethasone as adjuvants in patients undergoing CD. Primary outcomes were postoperative pain scores (VAS) and time to first analgesia request. Secondary endpoints included heart rate (HR) and postoperative nausea and vomiting (PONV). Pooled mean differences (MD) and risk ratios (RR) were calculated with 95% confidence intervals (CI) using a random-effects model.</p> Results <p>Six RCTs comprising 460 patients were included, with 230 (50%) receiving dexmedetomidine. Compared with dexamethasone, dexmedetomidine significantly reduced VAS at 4&#xa0;h (MD -0.88; 95% CI: -1.60 to -0.17; <i>p</i> = 0.016), while dexamethasone was superior at 24&#xa0;h (MD 0.72; 95% CI: 0.02 to 1.42; <i>p</i> = 0.043). There were no significant differences for VAS at 12&#xa0;h. Dexmedetomidine was associated with lower HR at 2 and 4&#xa0;h and reduced the incidence of PONV (RR 0.19; 95% CI: 0.04 to 0.81; <i>p</i> = 0.025). Time to first analgesia request was similar between groups.</p> Conclusion <p>Our meta-analysis suggests that dexmedetomidine provided better early analgesia, lower HR at 2 and 4 hours and reduced PONV, while dexamethasone was more effective at 24 hours. Further RCTs are warranted to confirm these findings.</p>

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Dexmedetomidine Versus Dexamethasone as an Adjuvant in TAP Blocks for Cesarean Section: A Meta-Analysis of Randomized Clinical Trials

  • 期刊论文

  • 发表日期：

    2026年8月5日

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  • Marcela da Silva Kazitani Cunha,
  • Lucas Mendes Barbosa,
  • Acza Kalica Buarque da Silva,
  • Carlos Henrique de Oliveira Ferreira,
  • Leonardo Reischoffer do Nascimento,
  • Lucas Cael Azevedo Ramos Bendaham,
  • Thaís Ribeiro Peclat,
  • Michaela K. Farber,
  • Jason Hirsch,
  • Elaine Gomes Martins,
  • Natália Marques Moreti

摘要

Background

Cesarean Delivery (CD) often causes moderate to severe postoperative pain. The transversus abdominis plane (TAP) block reduces somatic pain after lower abdominal surgeries; however, its duration is limited when local anesthetics are used alone. Adjuvants like dexmedetomidine and dexamethasone are used to prolong analgesia, but their comparative efficacy in TAP block for CD remains uncertain.

Methods

We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing dexmedetomidine and dexamethasone as adjuvants in patients undergoing CD. Primary outcomes were postoperative pain scores (VAS) and time to first analgesia request. Secondary endpoints included heart rate (HR) and postoperative nausea and vomiting (PONV). Pooled mean differences (MD) and risk ratios (RR) were calculated with 95% confidence intervals (CI) using a random-effects model.

Results

Six RCTs comprising 460 patients were included, with 230 (50%) receiving dexmedetomidine. Compared with dexamethasone, dexmedetomidine significantly reduced VAS at 4 h (MD -0.88; 95% CI: -1.60 to -0.17; p = 0.016), while dexamethasone was superior at 24 h (MD 0.72; 95% CI: 0.02 to 1.42; p = 0.043). There were no significant differences for VAS at 12 h. Dexmedetomidine was associated with lower HR at 2 and 4 h and reduced the incidence of PONV (RR 0.19; 95% CI: 0.04 to 0.81; p = 0.025). Time to first analgesia request was similar between groups.

Conclusion

Our meta-analysis suggests that dexmedetomidine provided better early analgesia, lower HR at 2 and 4 hours and reduced PONV, while dexamethasone was more effective at 24 hours. Further RCTs are warranted to confirm these findings.