Effect of dexmedetomidine versus dexamethasone in quadratus lumborum block on postoperative pain and inflammatory markers after cesarean section

Abstract

Background and Aims: Effective postoperative analgesia after cesarean section is essential for early mobilization, maternal comfort, and optimal recovery. The quadratus lumborum block provides both somatic and visceral analgesia, and its clinical performance may be enhanced by adjuvants. Dexmedetomidine and dexamethasone are commonly used adjuvants, yet their comparative benefits in obstetric anesthesia remain incompletely defined. This study aimed to compare the analgesic efficacy and physiological effects of dexmedetomidine versus dexamethasone as adjuvants to quadratus lumborum block (QLB) in patients undergoing cesarean section.Materials and Methods: In this randomized controlled study, 48 ASA II parturients undergoing cesarean section were allocated into two equal groups: dexmedetomidine (DEX group, n=24) and dexamethasone (DEXA group, n=24). All patients received ultrasound-guided QLB with levobupivacaine combined with either adjuvant. Postoperative pain intensity was assessed using Visual Analogue Scale (VAS) scores at 0 minutes, 6 hours, and 24 hours. Systemic stress and inflammatory responses were evaluated via serum cortisol levels and neutrophil-lymphocyte ratio (NLR). Rescue analgesia timing, opioid consumption, and adverse events were also recordedResults: Baseline characteristics were comparable between groups. The DEX group demonstrated significantly lower VAS scores at all postoperative time points. Cortisol levels at 6 and 24 hours were significantly reduced in the DEX group, accompanied by a greater decline from baseline. NLR values were significantly lower in the DEX group at early postoperative measurements. The time to first rescue analgesia was longer and fewer patients required rescue analgesia in the DEX group. Opioid consumption was numerically lower but not statistically different. Adverse events were mild and comparable between groups.Conclusion: Dexmedetomidine as an adjuvant to quadratus lumborum block (QLB) provides superior postoperative analgesia and attenuates stress and inflammatory responses compared with dexamethasone in cesarean section patients.

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