Background: Patients and physicians face difficulties with labor pain, which is characterized by both visceral and somatic components. The best method for reducing pain during labor with prolonged labor and hypotension is epidural analgesia. As a supplement to local anesthetics during normal vaginal delivery, this study compares the analgesic efficacy, maternal hemodynamic stability, and fetal outcomes of intravenous versus epidural administration of dexmedetomidine.

Methods: this study is double blinded randomized controlled study. We randomly assigned 60 full-term primigravida women who were having a normal vaginal delivery to each of three groups: Group I had epidural bupivacaine and IV placebo for epidural analgesia, Group II received epidural bupivacaine and dexmedetomidine, and Group III received epidural bupivacaine and continuous intravenous infusion of dexmedetomidine.

The Visual Analog Scale (VAS), which measures onset of effective analgesia, was the primary outcome. Fetal outcomes, the 1ST rescue analgesia sedation levels, and maternal hemodynamics were secondary outcomes.

Results: The intravenous dexmedetomidine group (Group III) had a substantially earlier onset of analgesia (VAS ≤ 3) and lower maternal pulse rate and mean arterial pressure throughout labor than the other two groups (p < 0.05), without negative effects on fetal Apgar scores were noted. Both the intravenous and epidural dexmedetomidine groups scored higher on sedation and consumed fewer opioids than the control group.

Conclusion: Since intravenous dexmedetomidine offers quick and efficient analgesia during normal vaginal birth, it can be utilized as a supplement to epidural bupivacaine. Additionally, adding dexmedetomidine epidurally results in better hemodynamic stability and analgesia .