Analysis of Adjuvant Medication Use During Cesarean Delivery Under Neuraxial Anesthesia

Intraoperative pain during cesarean delivery under neuraxial anesthesia occurs in up to 17% of patients and can adversely affect maternal psychological well-being. When neuraxial anesthesia is inadequate, intravenous (IV) adjuvant medications can be administered as part of patient-centered care. The ASA Committee on Obstetric Anesthesia includes adjuvant medication use during cesarean delivery as a suggested quality metric, but evidence guiding best practice is limited. We examined the frequency and patterns of IV adjuvant use during cesarean delivery under neuraxial anesthesia at an academic medical center.

A total of 716 cesarean deliveries performed under neuraxial anesthesia were reviewed. 236 cases (33%) required intraoperative adjuvant medications. Epidural cases required greater adjuvant use (38%) compared to spinal/CSE cases (30%), χ² = 4.51, p = 0.034. The most common adjuvants were IV fentanyl (46.6%) and dexmedetomidine (36.1%). Dexmedetomidine was predominantly used in anti-shivering doses (<30 µg, 76%). English-speaking patients were significantly more likely to receive adjuvants (p = 0.002). No significant difference in neonatal APGAR scores was observed between groups (p = 0.95).