Dexamethasone compared to dexmedetomidine as parasternal block adjunct in cardiac surgery patients: an observational study.

Abstract

Abstract Background: Pain after cardiac surgery sternotomy is severe and compromises the respiratory mechanism leading to a delayed extubation. The parasternal block provides a long-lasting pain relief when performed with the use of adjuvants such as dexmetedomidine or dexamethasone resulting in early extubation and reduced length of stay in intensive care unit. Methods: At the end of surgery, a bilateral superficial ultrasound parasternal block was performed with a 30 ml (15 ml per chest side) of 0.375% levobupivacaine (112,5 mg in total) Patients were allocated into two groups: patients without diabetes (n=125) received 0.1 mg/kg of dexamethasone; patients with diabetes (n= 222) received dexmedetomidine 1 mcg/kg. Results: Weaning time from ventilator or self-reported pain severity did not show any statistically significant differences between the 2 groups. In 45.8%, VAS score 0 or no pain, was reported as early as the baseline examination 4 hours following the end of surgery. After 12 hours, this percentage rises to 97.1% up to 24 hours. Conclusions: No statistically significant differences in postoperative cardiac surgery pain relief between dexamethasone and dexmedetomidine groups. Both dexamethasone and dexmetedomidine were effective as adjuvants on pain relief at 4 up to 24 postoperative hours. Weaning time from ventilator did not show any statistically significant differences between the two groups.