Research ArticleResearchMedication Safety

Randomized trial of 66 cardiac surgery patients shows dexmedetomidine in parasternal plane block extends post-sternotomy analgesia and cuts 24-hour opioids

Heart & lung : the journal of critical care (PubMed)Sep 18, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A randomized controlled trial of 66 adult cardiac surgery patients undergoing median sternotomy found that adding dexmedetomidine to bilateral transversus thoracic muscle plane blocks significantly prolonged time to first rescue analgesia and reduced 24-hour postoperative fentanyl consumption compared to bupivacaine alone.

What NurseJet pulled from the source

Post-sternotomy pain contributes significantly to delayed respiratory recovery, prolonged mechanical ventilation, and hemodynamic instability in cardiac intensive care units. In this randomized controlled trial, 66 adult patients (ASA physical status I–III) scheduled for open cardiac surgery via median sternotomy received bilateral ultrasound-guided transversus thoracic muscle plane blocks (TTPB) following induction of anesthesia. Participants were randomized to three groups: dexamethasone (0.25% bupivacaine plus 8 mg dexamethasone), dexmedetomidine (0.25% bupivacaine plus 1 mcg/kg dexmedetomidine), and control (0.25% bupivacaine alone). The primary outcome was time to first rescue analgesia following extubation. Time to first rescue analgesia was significantly longer in the dexmedetomidine group compared with the dexamethasone and control cohorts (p < 0.001). Total 24-hour postoperative fentanyl consumption was significantly reduced in both the dexmedetomidine and dexamethasone groups compared to controls (p < 0.001), accompanied by consistently lower numerical pain scores. Extubation times and intraoperative fentanyl consumption were comparable across all three arms (p > 0.05).

Why this matters for nurses

Cardiothoracic ICU nurses manage intense acute post-sternotomy pain where excessive opioid use risks respiratory depression, delayed weaning, delirium, and ileus. Regional plane blocks with prolonged action facilitate smooth recovery, deeper spontaneous breaths, earlier incentive spirometry, and reduced systemic opioid exposure without hindering timely extubation in recovering cardiac surgical patients.

Bedside takeaway

In an RCT of 66 cardiac surgery patients, adding dexmedetomidine or dexamethasone to parasternal plane blocks significantly cut 24-hour opioid consumption and improved pain control.

Key takeaways

Randomized trial evaluated bilateral transversus thoracic muscle plane blocks in 66 cardiac surgery patients.
Dexmedetomidine as an adjuvant significantly lengthened the duration of pain relief prior to first rescue analgesia (p < 0.001).
Both dexmedetomidine and dexamethasone significantly diminished total 24-hour postoperative fentanyl consumption (p < 0.001).
Postoperative pain scores were consistently lower in both adjuvant cohorts compared to plain bupivacaine.
Neither adjuvant delayed postoperative extubation times or altered intraoperative opioid requirements.

Practice implications

In postoperative sternotomy patients receiving ultrasound-guided parasternal blocks with adjuvants, anticipate prolonged analgesia; perform routine multimodal pain and sedation assessments, monitor for adjuvant-related bradycardia or hypotension, and encourage early pulmonary toilet as pain remains well controlled.

Limitations & cautions

Single-center trial in 66 patients; limited to elective adult cardiac procedures (ASA I–III); did not evaluate long-term persistent post-sternotomy pain or chronic opioid use after hospital discharge.
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Heart & lung : the journal of critical care (PubMed)

Heart & lung : the journal of critical care (PubMed). 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.

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https://pubmed.ncbi.nlm.nih.gov/42759104/

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This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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European journal of emergency medicine : official journal of the European Society for Emergency Medicine (PubMed)Oct 27, 2026Systematic Review

A systematic review of 11 studies covering 10,115 emergency department patients with chest pain found that commercial point-of-care high-sensitivity cardiac troponin assays achieve 96.3% to 100% sensitivity and 98.1% to 100% negative predictive value for ruling out acute myocardial infarction upon arrival.

Emergency TelemetryAI summaryReview source

Systematic ReviewResearchWorkflowAI summary · original source linked below

High-sensitivity cardiac troponin (hs-cTn) assays have transformed emergency chest pain triage, but standard central laboratory processing often incurs turnaround delays exceeding an hour. This systematic review evaluated 11 studies (including both derivation and validation cohorts) comprising 10,115 adult ED patients presenting with chest pain suggestive of acute coronary syndrome to determine the diagnostic accuracy of four commercial point-of-care hs-cTn devices with turnaround times under 20 minutes. Applied as a single-test rule-out upon ED arrival, high sensitivity and negative predictive value (NPV) were documented: Atellica VTLi demonstrated 98.8% to 100% sensitivity for troponin <4 ng/L (NPV 99.8%–100%) and 100% sensitivity for <7 ng/L (NPV 100%); Pathfast showed 96.3% to 100% sensitivity for <3 ng/L (NPV 98.1%–100%); i-STAT achieved 99.8% sensitivity for <5 ng/L (NPV 100%); and TriageTrue achieved 100% sensitivity for <3 ng/L (NPV 100%). Serial testing using the 99th percentile across 0- to 3-hour protocols yielded variable sensitivities (VTLi 64.8%–100%, Pathfast 83%–87%, and TriageTrue 79.8%), demonstrating that POC assays are most reliable when utilized for rapid arrival rule-out at low thresholds.

Key takeaways

Systematic review analyzed 11 derivation and validation studies encompassing 10,115 emergency chest pain patients.
Point-of-care hs-cTn devices provided rapid turnaround times (<20 minutes) suitable for bedside emergency testing.
Single-test arrival rule-out achieved 96.3% to 100% sensitivity and 98.1% to 100% negative predictive value across four commercial devices.
Serial protocols at the 99th percentile exhibited broader sensitivity variability (64.8% to 100%), favoring arrival threshold pathways.
Integration into clinical decision protocols can expedite low-risk rule-out while central laboratory confirmation remains prudent for ambiguous presentations.

Why this matters on shift

Emergency nurses triage hundreds of potential acute coronary syndrome presentations where rapid risk stratification prevents bed overcrowding and expedites definitive interventions. Understanding that verified bedside hs-cTn devices deliver lab-comparable rule-out accuracy in under 20 minutes allows triage nurses and rapid-assessment teams to accelerate clinical decision-making, shorten emergency stays, and safely reassure low-risk individuals.

Bedside takeaway

A systematic review of 10,115 emergency patients showed point-of-care high-sensitivity troponin assays rule out acute myocardial infarction upon arrival with 96.3% to 100% sensitivity.

Nursing implications

When evaluating acute chest pain using point-of-care hs-cTn platforms, recognize that extremely low arrival concentrations offer high negative predictive value for acute myocardial infarction, but adhere strictly to facility serial draw algorithms and ECG evaluations for indeterminate or evolving symptoms.

Limitations & cautions

Review included both derivation and prospective validation studies evaluated via QUADAS-3; diagnostic accuracy varied considerably when serial testing was evaluated at the 99th percentile rather than arrival rule-out thresholds; devices cannot replace continuous electrocardiographic monitoring or clinical risk scoring.
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Citations · exact source links

European journal of emergency medicine : official journal of the European Society for Emergency Medicine (PubMed). Diagnostic accuracy of high-sensitivity point-of-care troponin assays in emergency department for patients presenting with chest pain: a systematic review.

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The American journal of emergency medicine (PubMed)Jul 27, 2026Systematic Review

An updated systematic review and meta-analysis of five randomized controlled trials comprising 404 chest trauma patients demonstrated that applying suction following tube thoracostomy significantly shortened chest tube duration by 2.95 days and hospital stay by 3.98 days compared with water seal.

Med-Surg EmergencyAI summaryReview source

Systematic ReviewResearchWorkflowAI summary · original source linked below

Optimal drainage management following tube thoracostomy for traumatic pneumothorax and hemothorax remains a subject of ongoing clinical debate between continuous suction and passive water seal systems. In this updated systematic review and meta-analysis searching PubMed, Embase, Web of Science, and Cochrane CENTRAL through May 2026, researchers pooled data from five randomized controlled trials encompassing 404 trauma patients. Compared to water seal management, suction significantly reduced chest tube duration (mean difference [MD]: -2.95 days, 95% CI: -4.58 to -1.31; p = 0.0004) and hospital length of stay (MD: -3.98 days, 95% CI: -5.70 to -2.27; p < 0.00001). Furthermore, suction significantly increased the likelihood of achieving full lung expansion (OR: 4.86, 95% CI: 1.70–13.88; p = 0.003). Minimal clinically important difference (MCID) analysis confirmed meaningful benefits across all three parameters. Rates of recurrent pneumothorax, re-intervention, and retained or clotted hemothorax did not differ significantly between groups.

Key takeaways

Meta-analysis synthesized 5 randomized controlled trials comprising 404 patients with traumatic chest injuries.
Continuous suction shortened chest tube indwelling duration by nearly three days (MD -2.95 days, p = 0.0004).
Hospital length of stay was significantly reduced by approximately four days with suction (MD -3.98 days, p < 0.00001).
Patients on suction were nearly five times more likely to achieve full lung expansion (OR 4.86, p = 0.003).
No significant differences were identified in recurrent pneumothorax, clotted hemothorax, or re-intervention rates.

Why this matters on shift

Surgical and medical-surgical nurses care daily for trauma patients with chest drainage systems. Tube thoracostomy carries substantial pain, impairs pulmonary mechanics, and limits ambulation. Demonstrating that proactive suction management promotes faster pleural re-expansion and significantly reduces both tube duration and hospital stay provides bedside nurses and trauma teams with evidence to question prolonged passive water seal strategies in traumatic injury.

Bedside takeaway

A meta-analysis of 5 RCTs and 404 trauma patients found suction after tube thoracostomy reduced chest tube duration by 2.95 days and hospital stay by 3.98 days compared to water seal.

Nursing implications

Monitor chest drainage systems actively according to provider orders; when suction is prescribed, maintain prescribed negative pressure (-20 cm H2O), assess air leak chambers and drainage volumes regularly, and facilitate early incentive spirometry to optimize lung expansion.

Limitations & cautions

All included trials exhibited high risk of bias due to lack of clinician and outcome assessor blinding, which could influence subjective removal decisions; small sample size (404 patients across 5 trials) limited statistical power to assess complications such as clotted hemothorax.
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Citations · exact source links

The American journal of emergency medicine (PubMed). Comparative effectiveness of suction versus water seal following tube thoracostomy in traumatic pneumothorax and hemothorax: An updated systematic review and meta-analysis.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

JAMA (PubMed)Oct 24, 2026Systematic Review

A systematic review and meta-analysis of 85 randomized controlled trials encompassing 70,543 participants found that SGLT2 inhibitor therapy was associated with small, statistically significant increases in hemoglobin (+0.60 g/dL), hematocrit (+2.36%), and erythropoietin (+2.11 mIU/mL).

Med-Surg TelemetryAI summaryReview source

Systematic ReviewResearchMedication SafetyAI summary · original source linked below

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are widely prescribed across chronic heart failure, type 2 diabetes, and chronic kidney disease, where retrospective observations frequently note concurrent elevations in red blood cell indices. In this systematic review and meta-analysis searching PubMed, Web of Science, and CENTRAL through July 22, 2026, researchers pooled data from 85 double-masked randomized clinical trials (median duration 24 weeks; IQR 12–32 weeks) covering 70,543 patients (mean age 62.4 +/- 9.4 years; 35.9% female). Seventy-eight trials compared SGLT2 inhibitors against placebo, and seven utilized active comparators (primarily sitagliptin). From baseline to follow-up, hemoglobin increased by 0.55 g/dL with SGLT2 inhibitors versus a 0.08 g/dL decrease in control cohorts (net between-group difference 0.60 g/dL, 95% CI: 0.55–0.66 g/dL; p < 0.001). Hematocrit changed by +2.17% versus -0.13% in controls (difference 2.36%, 95% CI: 2.19%–2.52%; p < 0.001). Analysis of secondary erythropoietic and iron parameters demonstrated a significant increase in serum erythropoietin (difference 2.11 mIU/mL, 95% CI: 0.50–3.71; p = 0.01) and a significant reduction in transferrin saturation (difference -0.84%, 95% CI: -1.21% to -0.47%; p < 0.001).

Key takeaways

Systematic review analyzed 85 double-masked RCTs encompassing 70,543 patients across cardiology, nephrology, and endocrinology.
SGLT2 inhibitors produced modest but statistically significant increases in hemoglobin (+0.60 g/dL) and hematocrit (+2.36%).
Therapy was associated with stimulated erythropoiesis, evidenced by an increase in serum erythropoietin (+2.11 mIU/mL, p = 0.01).
Transferrin saturation decreased slightly (-0.84%, p < 0.001), reflecting increased iron utilization during erythropoiesis.
Authors emphasized that clinical significance remains uncertain and SGLT2 inhibitors should not be prescribed for the primary intent of treating anemia.

Why this matters on shift

Nurses administer SGLT2 inhibitors (such as empagliflozin, dapagliflozin, and canagliflozin) daily on medical-surgical, cardiac, and renal units. When reviewing routine complete blood count panels, nurses observing slight elevations in hemoglobin or hematocrit must recognize this as a known physiologic class effect mediated by hemoconcentration and mild erythropoietin stimulation, rather than misinterpreting it as acute dehydration or treating SGLT2 inhibitors as an anemia cure.

Bedside takeaway

In a meta-analysis of 85 RCTs and 70,543 patients, SGLT2 inhibitors led to small increases in hemoglobin (+0.60 g/dL) and erythropoietin (+2.11 mIU/mL), though clinical significance is unclear.

Nursing implications

Anticipate modest increases in hemoglobin and hematocrit when monitoring patients on SGLT2 inhibitors; differentiate expected class-related hemoconcentration and erythropoietin stimulation from acute volume depletion, and continue reinforcing fluid balance and medication adherence.

Limitations & cautions

The observed hematologic elevations were small (+0.60 g/dL hemoglobin), and the clinical importance of these changes remains unproven; trials were not designed to test clinical anemia endpoints or symptomatic benefit; SGLT2 inhibitors are not approved for anemia therapy.
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Citations · exact source links

JAMA (PubMed). Sodium-Glucose Cotransporter 2 Inhibitor Use and Levels of Hemoglobin, Markers of Iron Metabolism, and Erythropoiesis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

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Key takeaways

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Exact source links

More updates for this clinical area

Systematic review of 10,115 emergency chest pain patients finds point-of-care high-sensitivity troponin reliably rules out acute myocardial infarction on arrival

Meta-analysis of 404 chest trauma patients finds post-thoracostomy suction reduces chest tube duration by 3 days and hospital stay by 4 days versus water seal

Meta-analysis of 85 randomized trials and 70,543 patients links SGLT2 inhibitors to small increases in hemoglobin and erythropoietin