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.

中文翻译：

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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预后产生负面影响。使用阿片类药物和/或非甾体类抗炎药物进行常规治疗有几个缺点。右美托咪定是一种选择性 α2 激动剂，用于镇静和镇痛。使用右美托咪定治疗心脏手术患者术后疼痛以及减少谵妄和躁动仍存在争议。我们的目的是确定早期给予右美托咪定在减少心脏手术后阿片类药物使用中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 月期间在两个心脏中心进行冠状动脉旁路移植术 (CABG) 后入住心脏外科重症监护病房 (CSICU) 的 120 名患者的医疗记录。患者被分为两组。 A 组包括 55 名在进入 CSICU 时接受右美托咪定剂量为 0.2-0.4 mcg/kg/h 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 小时的疼痛评分。右美托咪定组的疼痛评分显着下降，持续到术后第 3、6、8 和 12 小时读数，平均改良 Ramsay 评分分别为 0.1 ± 0.0、0.89 ± 2.05、0.35 ± 0.1 和 0.12 ± 1.1 B 组为 0.46 ± 1.15、3.46 ± 2.93、0.98 ± 1.90 和 0.12 ± 1.1 (p < 0.001)，所接受的累积吗啡显着下降 (p < 0.001，OR = 909，95% CI 0.05–0.19) ，与另一组的 96 ± 8.8 b/min 相比，右美托咪定组的心率有利地降低 (80 ± 1.9 b/min) (p = 0.017)，全身麻醉恢复更顺利。术后早期给予右美托咪定是安全的。它可以减少阿片类药物的使用，具有镇静、镇痛和解交感作用，在冠状动脉搭桥患者的治疗过程中发挥有用的作用，并可以改善术后恢复。