Dexmedetomidine Versus Dexamethasone as Adjuvants to Bupivacaine for Wound Infiltration After Caesarean Section Under Spinal Anaesthesia

Objective: Postoperative pain control is central to recovery after caesarean section.As wound infiltration is a standard multimodal analgesia component, we compared dexmedetomidine and dexamethasone as bupivacaine adjuvants for wound infiltration in women undergoing elective caesarean section under spinal anaesthesia, focusing on analgesic performance and safety.Methods: This prospective, randomised, double-blind trial enrolled 90 American Society of Anesthesiologists (ASA) physical status II women scheduled for elective caesarean section, divided equally into three groups: 0.25% bupivacaine alone (Group B), bupivacaine with dexmedetomidine 1 μg/kg (Group BDM), or bupivacaine with dexamethasone 8 mg (Group BDX).The main measure was total tramadol use over the first postoperative day; other measures included time to first rescue dose, Visual Analogue Scale (VAS) pain scores, patient satisfaction, haemodynamic readings, sedation, and adverse events.Results: Tramadol use varied significantly by group (P<0.0001)-lowest in Group BDM (87.33 ± 17.40 mg), followed by Group BDX (129.43 ± 15.61 mg) and Group B (150.33 ± 14.59 mg).Time to first rescue analgesia was longest in Group BDM (6.00 ± 0.10 hours), then Group BDX (4.00 ± 2.03 hours) and Group B (1.87 ± 0.35 hours) (P<0.0001).Both adjuvants outperformed bupivacaine alone for pain control, with dexmedetomidine giving the strongest analgesia and highest satisfaction scores.Haemodynamics, sedation, and adverse event rates were similar across groups.Conclusion: Adding dexmedetomidine or dexamethasone to bupivacaine improved postoperative analgesia after caesarean section.Dexmedetomidine provided greater opioid sparing, longer analgesia, superior pain control, and higher patient satisfaction without compromising safety, supporting its use as an effective adjunct to bupivacaine wound infiltration.