Dexmedetomidine-containing patient-controlled intravenous analgesia after elective caesarean delivery: a retrospective cohort study

BackgroundDexmedetomidine is used as an adjunct in multimodal postoperative analgesia, but evidence from routine clinical care after caesarean delivery remains limited. We evaluated whether dexmedetomidine-containing patient-controlled intravenous analgesia (PCIA) was associated with postoperative analgesic and early recovery outcomes.MethodsThis single-centre retrospective cohort study included women aged 18–45 years undergoing elective term caesarean delivery between January and September 2025. Women were classified according to the initial postoperative PCIA regimen as receiving dexmedetomidine-containing or conventional PCIA. The primary outcome was movement pain on a 0–10 numerical rating scale at 24 h. Secondary outcomes included pain through 48 h, sufentanil delivery, patient-controlled analgesia demands, rescue analgesia, treatment-related events, and early recovery milestones. Propensity-score overlap weighting was used for the primary analysis. Propensity-score matching, conventional multivariable adjustment, complete-case and restricted-cohort analyses, and an expanded propensity-score model incorporating attending anaesthesiologist and calendar month were used to assess robustness.ResultsAmong 304 eligible women, 132 received dexmedetomidine-containing PCIA and 172 received conventional PCIA. Mean movement pain at 24 h was 3.1 (SD 1.2) versus 3.7 (SD 1.3), corresponding to an overlap-weighted mean difference of −0.51 points (95% CI −0.80 to −0.22; P < 0.001). The primary estimate was similar across sensitivity analyses, including the expanded propensity-score model incorporating attending anaesthesiologist and calendar month. Among 290 women with complete 48-h pump records, median cumulative sufentanil delivery was 84 μg (IQR 78–91) versus 90 μg (82–98; median difference −5.2 μg, 95% CI −7.8 to −2.6; P < 0.001). Rescue analgesia was required in 24 of 132 women (18.2%) versus 46 of 172 (26.7%; risk ratio 0.72, 95% CI 0.52–0.99; P = 0.044). First mobilisation occurred at 16.9 versus 19.3 h (time ratio 0.89, 95% CI 0.84–0.95; P < 0.001), and first passage of flatus at 25.8 versus 28.9 h (time ratio 0.92, 95% CI 0.86–0.98; P = 0.012). Estimates for uncommon adverse events were imprecise.ConclusionsIn this retrospective cohort, dexmedetomidine-containing PCIA was associated with modestly lower early movement pain and lower analgesic requirements, with shorter observed times to selected early recovery milestones. Estimates for uncommon adverse events did not establish safety equivalence. These observational findings should not be interpreted as establishing a causal treatment effect.