Epidural-Related Fever and Cesarean Delivery: Comparing Ropivacaine/Dexmedetomidine and Ropivacaine/Sufentanil: A Single-Center Randomized Controlled Study in 695 Women

BACKGROUND Epidural analgesia during labor is known to increase the risk of intrapartum hyperthermia, which can lead to higher cesarean section rates and antibiotic use due to the difficulty in distinguishing it from intrapartum infections. This study investigated the impact of 2 epidural analgesic combinations - ropivacaine/dexmedetomidine and ropivacaine/sufentanil - on the incidence of cesarean deliveries prompted by intrapartum hyperthermia. MATERIAL AND METHODS In this single-center, randomized controlled trial, 695 pregnant women were assigned to receive ropivacaine with either dexmedetomidine (Dex group, n=322) or sufentanil (control, C group, n=326) for labor epidural analgesia. We introduced the concept of 'cesarean delivery due to epidural-related fever' and evaluated the incidence of hyperthermia, overall cesarean delivery rates, and cesarean deliveries specifically due to epidural-related fever in both groups. RESULTS The Dex group exhibited a significantly lower incidence of hyperthermia compared with the C group (18.0% vs 28.5%, P=0.002). Additionally, cesarean deliveries due to epidural-related fever were notably reduced in the Dex group (0.9% vs 5.2%, P=0.02). No significant differences were observed between the groups in overall cesarean delivery rates (25.5% vs 25.2%, P=0.927), or in neonatal Apgar scores ≤7 at 1 minute (5.3% vs 5.2%, P=0.971) and 5 minutes (0.0% vs 1.2%, P=0.136). CONCLUSIONS This study is the first to identify 'cesarean delivery due to epidural-related fever' as a distinct factor influencing cesarean rates. Epidural dexmedetomidine significantly reduced the incidence of such fever, thereby decreasing the rate of cesarean deliveries attributed to it. These findings suggest a potential advantage of using dexmedetomidine in labor epidural analgesia to improve maternal outcomes.