2026 Clinician Corner - Treatment of breakthrough labor pain with epidural dexmedetomidine: a case series

Abstract 

Hydrophilic polymer embolism (HPE) is a rare complication of endovascular procedures caused by embolization of polymer coatings from vascular devices. We report a 72-year-old man with peripheral artery disease, diabetes, and chronic kidney disease who developed painful, nonhealing lower-extremity ulcers presenting shortly after vascular stenting. Initial biopsies Breakthrough labor pain, defined as the return of pain despite ongoing administration of neuraxial analgesia, poses a significant challenge within the field of obstetric anesthesia. Epidural adjunct medications may be used to enhance neuraxial block density or provide coverage to previously spared regions. Dexmedetomidine, a US Food and Drug Administration–approved selective alpha-2 adrenergic agonist, has gained attention for an off-label use as a labor epidural adjunct medication for labor analgesia. This case series highlights three cases of epidural dexmedetomidine use for breakthrough pain during labor. 

Keywords:  Dexmedetomidine; epidural analgesia; labor pain; obstetrical anesthesia

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on March 1, 2027.

Learning Objectives

After completing the article, the learner should be able to:

  • Apply the principles regarding the use of epidural dexmedetomidine as an adjunct for management of labor pain in unique clinical environments.  

  • Understand the potential benefits of off-label use of epidural dexmedetomidine for breakthrough labor pain, a potential option for enhancing analgesia density and spread distribution. 

     

Key Points 

  • Epidural dexmedetomidine may play a role in patients with an appropriate sensory block on exam but persistent breakthrough pain.   

  • Providers may consider epidural dexmedetomidine as an adjunct medication in unique situations when there is a technically difficult placement with resultant inadequate density or spared regions of the block, or in patients with a history of chronic pain. 

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Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
03/01/2026
Course expires: 
03/01/2027
Cost:
$25.00

Allison Roecker, BS¹, Sovan Ven, BS², Sonali Batta, MD³, Annika Silfvast-Kaiser, MD3, Kirstin Altman, MD3, and Madeeha Drissi, MD3 

 

¹Texas A&M University College of Medicine, College Station, Texas, USA 

² Baylor College of Medicine, Houston, Texas, USA 

³ Department of Dermatology, Baylor Scott & White Medical Center –Temple, Temple, Texas, USA 

 

Corresponding author: Allison Roecker, BS, A&M University College of Medicine, College Station, Texas (e-mail: [email protected])

 The planners and faculty for this activity have no relevant financial relationships to disclose. The authors report no funding. The patient consented to publication of this case report. 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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