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Background <p>Visceral traction response (VTR) occurs in over 40% of cesarean delivery under spinal anesthesia. This study evaluated the efficacy and safety of intraoperative remimazolam combined with nalbuphine for attenuating VTR.</p> Methods <p>In this prospective, randomised, double-blind, placebo-controlled trial, 72 parturients undergoing elective cesarean delivery under spinal anesthesia received either remimazolam (0.05&#xa0;mg/kg) with nalbuphine (0.1&#xa0;mg/kg) (R + N group, <i>n</i> = 36) or normal saline (Placebo group, <i>n</i> = 36) after umbilical cord clamping. The primary outcome was positive traction response incidence.</p> Results <p>The R + N group demonstrated significantly lower positive traction response incidence (5.6% vs. 41.7%, <i>p</i> &lt; 0.001) and reduced VTR scores during abdominal exploration and suturing. The incidence of nausea (22.2% vs 58.3%, <i>p</i> = 0.002) and chest tightness (8.3% vs 36.1%,<i> p</i> = 0.005) was significantly lower in the R + N group. Maternal satisfaction was higher (9.56 ± 0.88 vs. 7.11 ± 1.47, <i>p</i> &lt; 0.001). No significant hemodynamic differences or serious adverse events occurred.</p> Conclusions <p>Remimazolam combined with nalbuphine significantly reduces VTR during cesarean delivery, providing effective sedation and analgesia while maintaining hemodynamic stability, representing a safe adjunct to neuraxial anesthesia.</p> Trial registration <p>Chinese Clinical Trial Registry ChiCTR2500108913, registered 9 September 2025.</p>

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Intraoperative remimazolam-nalbuphine infusion reduces visceral traction response during cesarean delivery: a randomised trial

  • 期刊论文

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  • 发表日期：

    2026年5月18日

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  • Juan Meng,
  • Xi-Shu Deng,
  • Run Han,
  • Shan Jiang,
  • Yu-Chen Zou,
  • Tao Zou,
  • Jian-Gui Gong,
  • Hong-Mei Bao,
  • Si-Ting Wang,
  • Suwas Bhandari,
  • Bo Feng,
  • Li-Ming Cheng

摘要

Background

Visceral traction response (VTR) occurs in over 40% of cesarean delivery under spinal anesthesia. This study evaluated the efficacy and safety of intraoperative remimazolam combined with nalbuphine for attenuating VTR.

Methods

In this prospective, randomised, double-blind, placebo-controlled trial, 72 parturients undergoing elective cesarean delivery under spinal anesthesia received either remimazolam (0.05 mg/kg) with nalbuphine (0.1 mg/kg) (R + N group, n = 36) or normal saline (Placebo group, n = 36) after umbilical cord clamping. The primary outcome was positive traction response incidence.

Results

The R + N group demonstrated significantly lower positive traction response incidence (5.6% vs. 41.7%, p < 0.001) and reduced VTR scores during abdominal exploration and suturing. The incidence of nausea (22.2% vs 58.3%, p = 0.002) and chest tightness (8.3% vs 36.1%, p = 0.005) was significantly lower in the R + N group. Maternal satisfaction was higher (9.56 ± 0.88 vs. 7.11 ± 1.47, p < 0.001). No significant hemodynamic differences or serious adverse events occurred.

Conclusions

Remimazolam combined with nalbuphine significantly reduces VTR during cesarean delivery, providing effective sedation and analgesia while maintaining hemodynamic stability, representing a safe adjunct to neuraxial anesthesia.

Trial registration

Chinese Clinical Trial Registry ChiCTR2500108913, registered 9 September 2025.