Postoperative pain has negative consequences on patients’ outcomes after cardiac surgery. Routine management with opioid and or non-steroidal anti-inflammatory medications has several disadvantages. Dexmedetomidine is a selective α2 agonist used for sedation and analgesia. The use of dexmedetomidine for postoperative pain management and decreasing delirium and agitation in cardiac surgery patients is a matter of debate. Our objective was to determine the role of an early administration of dexmedetomidine in decreasing opioid use post-cardiac surgery and its effects on the quality of postoperative recovery. Medical records of 120 patients admitted to the cardiac surgery intensive care unit (CSICU) after coronary artery bypass grafting (CABG) in two cardiac centers between December 2015 and December 2016 were reviewed. Patients were divided into two groups. Group A included 55 patients who received dexmedetomidine in a dose of 0.2–0.4 mcg/kg/h on admission to CSICU, and group B included 65 patients who did not receive dexmedetomidine. The primary outcome was the pain score immediately after extubation, and the secondary outcomes included post-extubation sedation and pain scores for 12 h. There were significant decrease of the pain scores in dexmedetomidine group that continues through the 3rd, 6th, 8th, and 12th hour readings after surgery with mean modified Ramsay scores 0.1 ± 0.0, 0.89 ± 2.05, 0.35 ± 0.1, and 0.12 ± 1.1 respectively compared to 0.46 ± 1.15, 3.46 ± 2.93, 0.98 ± 1.90, and 0.12 ± 1.1 in group B (p < 0.001), significant decrease in cumulative morphine received (p < 0.001, OR = 909, 95% CI 0.05–0.19), favorable reduction in heart rate in dexmedetomidine group (80 ± 1.9 b/min) compared to 96 ± 8.8 b/min in the other group (p = 0.017), and smoother recovery from general anesthesia. Administration of dexmedetomidine in the early postoperative period can be safe. It may reduce the use of opioids, has sedative, analgesic, and sympatholytic effects that could play a useful role during the management of coronary artery bypass patients, and may improve postoperative recovery.

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右美托咪定输注在冠状动脉搭桥术后的作用

术后疼痛对心脏手术后患者的结局具有负面影响。使用阿片类药物和/或非甾体类抗炎药进行常规治疗有几个缺点。右美托咪定是一种用于镇静和镇痛的选择性α2激动剂。右美托咪定在心脏手术患者中用于术后疼痛管理和减少del妄和躁动的使用尚存在争议。我们的目标是确定早期使用右美托咪定在减少心脏手术后使用阿片类药物的作用及其对术后恢复质量的影响。回顾了2015年12月至2016年12月之间在两个心脏中心接受冠状动脉旁路移植术（CABG）后入院的心脏外科重症监护病房（CSICU）的120例患者的病历。患者分为两组。A组包括55名在入CSICU时以0.2–0.4 mcg / kg / h的剂量接受右美托咪定的患者，B组包括65名未接受右美托咪定的患者。主要结局是拔管后立即的疼痛评分，次要结局包括拔管后镇静和12小时疼痛评分。右美托咪定组的疼痛评分显着降低，持续至术后第3、6、8和12小时，而平均Ramsey评分分别为0.1±0.0、0.89±2.05、0.35±0.1和0.12±1.1 B组降至0.46±1.15、3.46±2.93、0.98±1.90和0.12±1.1（p <0.001），吗啡的累积接受量显着下降（p <0.001，OR = 909，95％CI 0.05-0.19），右美托咪定组的心率降低有利（80±1.9 b / min），而另一组为96±8.8 b / min（p = 0.017），并且从全身麻醉中恢复较平稳。在术后早期给予右美托咪定是安全的。它可能会减少阿片类药物的使用，具有镇静，镇痛和交感神经作用，这些可能在冠状动脉搭桥术患者的治疗中发挥有用作用，并可能改善术后恢复。