INCIDENCE OF DELIRIUM WITH DEXMEDETOMIDINE COMPARED WITH FENTANYL BASED THERAPY IN POSTOPERATIVE CARDIAC SURGICAL PATIENTS: A RANDOMIZED CONTROLLED SINGLE BLINDED STUDY

Abstract

Background: Postoperative Delirium represents complication in cardiac surgery, associated with increased morbidity and mortality. This study compared the efficacy of dexmedetomidine versus fentanyl-based therapy on clinical outcomes in postoperative cardiac surgical patients. Methods: This study design was a single blinded Randomized Control Trial was conducted in tertiary hospitals in IMS and SUM between January 2023 to January 2025. Patients were randomized into two groups i.e., Dexmedetomidine (DEX) and fentanyl-based therapy in cardiac surgery patient. The primary endpoint was delirium incidence and severity, assessed 12-hourly for 7 days via CAM-ICU. Secondary outcomes included pain (CPOT/Wong-Baker), sedation (RASS), extubation time, and hemodynamic stability. Analysis was performed using SPSS v27, with significance set at p < 0.05. Results: One hundred fifty patients were randomized (n=75 per group) with no significant differences in age, weight, or gender. While delirium incidence was similar initially, Dexmedetomidine showed significantly lower mean delirium scores from day 5 to day 7 (p < 0.05) compared to Fentanyl. Additionally, Dexmedetomidine demonstrated significantly better sedation (RASS) and analgesia (CPOT) scores from 12 to 48 hours (p < 0.001). Furthermore, Dexmedetomidine group achieved significantly earlier extubation (17.54 ± 2.59 vs. 18.4 ± 3.16 hours; p = 0.03), lower incidences of tachyarrhythmias, and reduced rescue analgesia requirements. Hemodynamic parameters remained stable across both cohorts. Conclusions: Postoperative dexmedetomidine significantly reduced delirium severity, improves sedation quality, and provided superior analgesia compared to fentanyl. Dexmedetomidine is a more effective postoperative sedative analgesic than fentanyl, supports modern cardiac surgical protocols to improve clinical outcomes in high-risk populations.Background: Postoperative Delirium represents complication in cardiac surgery, associated with increased morbidity and mortality. This study compared the efficacy of dexmedetomidine versus fentanyl-based therapy on clinical outcomes in postoperative cardiac surgical patients. Methods: This study design was a single blinded Randomized Control Trial was conducted in tertiary hospitals in IMS and SUM between January 2023 to January 2025. Patients were randomized into two groups i.e., Dexmedetomidine (DEX) and fentanyl-based therapy in cardiac surgery patient. The primary endpoint was delirium incidence and severity, assessed 12-hourly for 7 days via CAM-ICU. Secondary outcomes included pain (CPOT/Wong-Baker), sedation (RASS), extubation time, and hemodynamic stability. Analysis was performed using SPSS v27, with significance set at p < 0.05. Results: One hundred fifty patients were randomized (n=75 per group) with no significant differences in age, weight, or gender. While delirium incidence was similar initially, Dexmedetomidine showed significantly lower mean delirium scores from day 5 to day 7 (p < 0.05) compared to Fentanyl. Additionally, Dexmedetomidine demonstrated significantly better sedation (RASS) and analgesia (CPOT) scores from 12 to 48 hours (p < 0.001). Furthermore, Dexmedetomidine group achieved significantly earlier extubation (17.54 ± 2.59 vs. 18.4 ± 3.16 hours; p = 0.03), lower incidences of tachyarrhythmias, and reduced rescue analgesia requirements. Hemodynamic parameters remained stable across both cohorts. Conclusions: Postoperative dexmedetomidine significantly reduced delirium severity, improves sedation quality, and provided superior analgesia compared to fentanyl. Dexmedetomidine is a more effective postoperative sedative analgesic than fentanyl, supports modern cardiac surgical protocols to improve clinical outcomes in high-risk populations.