Coronary artery bypass surgery (CABG), typically performed through a median sternotomy, causes significant postoperative pain. Managing this pain effectively while reducing reliance on opioids is essential, as opioids can lead to side effects such as respiratory depression, nausea, and potential for dependence. Regional anesthesia techniques like the erector spinae plane block (ESPB) have emerged as promising tools to control pain and support recovery.
This randomized, double-blind clinical trial evaluates whether adding dexmedetomidine, a sedative and analgesic, to ropivacaine, a local anesthetic, in bilateral ESPB can improve pain control after off-pump CABG surgery. The study is conducted at the Lebanese American University Medical Center - Rizk Hospital.
A total of 110 adult patients undergoing elective surgery are randomly assigned to one of two groups:
1. Group R: Receives ropivacaine alone in the ESPB. 2. Group RD: Receives ropivacaine with dexmedetomidine.
The nerve block is administered before anesthesia. The primary outcome is the duration of effective pain relief (pain score ≤4) before the patient needs opioid medication, assessed up to 24 hours after extubation.
Secondary outcomes include:
1. Pain scores monitored for up to 48 hours post-extubation 2. Total intraoperative opioid use 3. Time to extubation, ambulation, and incentive spirometry use 4. ICU stay duration 5. Side effects such as nausea, bradycardia, or local anesthetic toxicity
This study supports efforts to reduce opioid use after heart surgery while maintaining effective pain management, aligning with enhanced recovery protocols and addressing the broader public health challenge of opioid overuse.
Age range: 25 - 80 years old
Planned for elective OFF PUMP CABG
Cognitively not impaired
American Society of Anesthesiologists class 3
Refusal to participate in the study
Emergency surgery
American Society of Anesthesiologists class >3
Left ventricular ejection fraction <40%
Parallel
Dexmedetomidine
DrugDexmedetomidine added to ropivacaine in the bilateral single-shot Ultrasound-guided erector spinae plane block that will be applied to each side (bilateral): 20ml/side of 0.375% ropivacaine+0.5 μg/kg/side of dexmedetomidine (lean body weight if BMI \>30)
Ropivacaine
DrugRopivacaine only in the Bilateral single-shot Ultrasound-guided Erector Spinae Plane Block: 20ml/side of 0.375% ropivacaine
Analgesia time
The period during which the pain numerical rating scale score remains less than or equal to 4 and until the time the patient required the administration of opioid as the first administration. The numerical rating scale score is a 0-10 scale, where 0 represents "no pain" and 10 represents "worst pain imaginable".
Total intraoperative opioid
Total intraoperative opioid usage in terms of morphine equivalent
Total amount of rescue analgesics used
Rescue analgesia requirements, including morphine or other than morphine, includes the total amount of each rescue analgesic used
Pain score
Pain scores postoperatively related to chest pain: measured using the numerical rating scale to get pain scores on pre-specified time points. The minimum score is 0, "no pain at all," and the maximum score is 10, "worst possible pain."
Time to extubation
Time to first incentive spirometry use
Time to ambulation
Total length of ICU stay
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Lebanese American University
Lead sponsor
Lebanese American University Medical Center
Sponsor institution
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