Dexmedetomidine in Cesarean Section: Evidence‑Based Guidelines

Shivering Control in Cesarean Delivery

The 2026 guidelines published in American Journal of Obstetrics and Gynecology recommend dexmedetomidine as the highest‑ranked pharmacologic agent for preventing intra‑operative and post‑operative shivering during cesarean delivery, based on a meta‑analysis of 20 randomized controlled trials encompassing 1,983 participants (Level I evidence). 1
The same 2026 guidelines also state that dexmedetomidine can be administered intravenously, epidurally, or intrathecally for shivering prophylaxis in cesarean sections, providing flexibility in route of delivery while maintaining efficacy (Level I evidence). [1][2]3

As a neuraxial adjuvant, dexmedetomidine is incorporated together with local anesthetics and opioids in epidural catheters for intra‑operative pain management during cesarean delivery, enhancing analgesia without increasing motor block (expert consensus). 3

The 2016 American Society of Anesthesiologists (ASA) practice guidelines do not list specific contraindications for neuraxial α₂‑agonists in obstetrics; however, the FDA label cautions about the risk of maternal bradycardia and other cardiovascular effects when dexmedetomidine is used (moderate‑quality evidence). 4