K Said, Seddiki R, Serghini I
Emergency Medicine, Mohamed V Training Military Hospital, Rabat, MAR.
Anesthesiology, Hassan II Military Hospital, Marrakech, MAR.
Cureus. 2025 Jul 24;17(7):e88707. doi: 10.7759/cureus.88707. eCollection 2025 Jul.
Optimal management of postoperative pain after cardiac surgery remains a clinical priority. Glucocorticoids such as dexamethasone may enhance analgesia and reduce opioid requirements, but evidence specific to cardiac surgery is limited and mixed.
This study aimed to evaluate the effect of a single intraoperative dose of dexamethasone on early postoperative opioid consumption, pain intensity, and chronic postoperative pain incidence following elective cardiac surgery.
This retrospective observational study was conducted at Avicenna Military Hospital (Marrakech, MAR), a single tertiary center, from January 1, 202,2 to December 31, 2023. A total of 45 adult patients undergoing elective cardiac surgery via median sternotomy were included. Of whom, 22 received IV dexamethasone (0.1-0.2 mg/kg) after induction, while 23 received no corticosteroids. All patients received standardized multimodal analgesia with IV paracetamol and morphine via patient-controlled analgesia (PCA). Primary outcomes were cumulative IV morphine use on postoperative day one (POD1) and POD3. Secondary outcomes included pain scores (visual analog scale (VAS) 0-10) on POD1 and POD3 and chronic post-sternotomy pain at three months.
Dexamethasone significantly reduced morphine consumption on POD1 (12.2 ± 2.9 mg vs. 18.5 ± 3.8 mg, p < 0.001) and POD3 (6.1 ± 2.1 mg vs. 9.2 ± 2.7 mg, p < 0.001). The VAS scores were also lower in the dexamethasone group on POD1 (3.5 ± 1.0 vs. 5.6 ± 1.1, p < 0.001) and POD3 (2.0 ± 0.8 vs. 3.5 ± 1.0, p < 0.001). Chronic pain was reported in 18.2% of the dexamethasone group vs. 39.1% in controls at three months (risk difference -20.9%, p = 0.09), a clinically relevant trend despite not reaching statistical significance.
A single intraoperative dose of dexamethasone significantly reduces early postoperative opioid use and pain intensity in cardiac surgery. Although the reduction in chronic pain did not reach statistical significance, the observed trend suggests a potential long-term benefit. Further randomized trials with larger sample sizes are warranted to confirm these findings.
心脏手术后疼痛的最佳管理仍是临床重点。地塞米松等糖皮质激素可能增强镇痛效果并减少阿片类药物的用量，但针对心脏手术的证据有限且存在分歧。
本研究旨在评估术中单次给予地塞米松对择期心脏手术后早期阿片类药物用量、疼痛强度及慢性术后疼痛发生率的影响。
本回顾性观察性研究于2022年1月1日至2023年12月31日在单一三级中心阿维森纳军事医院（摩洛哥马拉喀什）进行。共纳入45例接受正中胸骨切开术的择期心脏手术成年患者。其中，22例在诱导后接受静脉注射地塞米松（0.1 - 0.2 mg/kg），23例未接受糖皮质激素治疗。所有患者均通过患者自控镇痛（PCA）接受静脉注射对乙酰氨基酚和吗啡的标准化多模式镇痛。主要结局指标为术后第1天（POD1）和第3天（POD3）静脉注射吗啡的累积用量。次要结局指标包括POD1和POD3时的疼痛评分（视觉模拟量表（VAS）0 - 10分）以及术后3个月的慢性胸骨切开术后疼痛。
地塞米松显著降低了POD1（12.2 ± 2.9 mg对18.5 ± 3.8 mg，p < 0.001）和POD3（6.1 ± 2.1 mg对9.2 ± 2.7 mg，p < 0.001）时的吗啡用量。地塞米松组在POD1（3.5 ± 1.0对5.6 ± 1.1，p < 0.001）和POD3（2.0 ± 0.8对3.5 ± 1.0，p < 0.001）时的VAS评分也更低。3个月时，地塞米松组有18.2%报告有慢性疼痛，而对照组为39.1%（风险差异 -20.9%，p = 0.09），尽管未达到统计学显著性，但这是一个具有临床意义的趋势。
术中单次给予地塞米松可显著降低心脏手术后早期阿片类药物的使用量和疼痛强度。尽管慢性疼痛的减少未达到统计学显著性，但观察到的趋势表明可能有长期益处。需要进一步进行更大样本量的随机试验来证实这些发现。
