Role of Dexamethasone in Reducing Postoperative Pain Following Cardiac Surgery: A Single-Center Retrospective Cohort Study.

BACKGROUND

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.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.