Dexamethasone as an Adjuvant to Erector Spinae Plane Block in Cardiac Surgery: A Randomized Controlled Trial on Postoperative Recovery and Pain chronification

Background and Objectives: Pain control after cardiac surgery remains suboptimal, and concerns about neuraxial techniques under anticoagulation limit the use of thoracic epidurals. The erector spinae plane (ESP) block offers a simple, safer alternative, but its duration is often short. Dexamethasone is a proven adjuvant that prolongs peripheral nerve block analgesia, yet its effect in fascial plane blocks during cardiac surgery is unclear. We tested whether adding dexamethasone to bilateral ESP blocks could enhance postoperative recovery and attenuate the development of chronic post-sternotomy pain after coronary artery bypass grafting (CABG). Methods : In this randomized, double-blind trial (NCT04313959), 43 patients undergoing elective CABG received bilateral ESP blocks with 0.2% ropivacaine alone (control, n  = 21) or ropivacaine plus 8 mg perineural dexamethasone (dexamethasone, n  = 22). Postoperative pain intensity (VAS/NRS), opioid consumption, and mechanical ventilation time were assessed, along with long-term pain via the Brief Pain Inventory at 30, 60, and 90 days. Results : Acute pain scores and 48-hour opioid use were similar between groups. However, dexamethasone significantly shortened mechanical ventilation (751 ± 333 vs 848 ± 236 min; p  = 0.041) and improved 30-day pain outcomes (worst pain 1.8 vs 2.2; p  = 0.002), with less interference in daily activities. By 60–90 days, pain and function had returned to comparable levels. No block-related or systemic complications occurred. Conclusions : Perineural dexamethasone did not reduce acute pain after CABG but facilitated earlier extubation and transiently improved subacute pain and recovery. These findings support its incorporation into enhanced-recovery protocols and justify larger multicenter trials to define its long-term benefits.