Comparison of analgesic efficacy of dexamethasone and dexmedetomidine as an adjuvant to local anaesthetic in transversus thoracic muscle plane block in adult patients undergoing median sternotomy: A randomised controlled trial.
Poonam Kumari, Lalit Jha, Amarjeet Kumar et al.
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In 30 seconds
This randomised controlled trial compared dexamethasone and dexmedetomidine added to bupivacaine for bilateral transversus thoracic muscle plane block in 66 adults undergoing cardiac surgery via median sternotomy. The primary outcome was time to first rescue analgesia after extubation. This interval was significantly longer with dexmedetomidine than with dexamethasone or bupivacaine alone (P 0.001). Both adjuvants were associated with lower 24-hour postoperative fentanyl consumption than control (P < 0.001), while opioid consumption was comparable between the two adjuvant groups.
Key findings
- Time to first rescue analgesia was significantly longer with dexmedetomidine than with dexamethasone or control (P 0.001).
- Twenty-four-hour postoperative fentanyl consumption was significantly lower with either adjuvant than with bupivacaine alone (P < 0.001).
- Postoperative pain scores were consistently lower in both adjuvant groups; extubation time and intraoperative fentanyl use were comparable across groups (P > 0.05).
Why it matters
Pain after median sternotomy can delay recovery, and this trial suggests that adding either adjuvant to bupivacaine in TTPB may improve postoperative analgesia and reduce opioid use compared with local anaesthetic alone. The longer time to rescue analgesia with dexmedetomidine may be relevant when considering block duration, although the abstract reports comparable postoperative opioid consumption between the adjuvants.
What to keep in mind
The trial included 66 patients, and the abstract does not report the magnitude of differences in analgesia or fentanyl consumption.