Perioperative Dexamethasone Does Not Reduce Postoperative Opioid Use Following Anterior Cervical Discectomy and Fusion

Yunsoo Lee; Tariq Ziad Issa; Teeto Ezeonu; Aditya Mazmudar; Mark J Lambrechts; Richard Padovano; Eric DiDomenico; Patrick O'Connor; Sebastian I Fras; John J Mangan; Giovanni Grasso; Jose A Canseco; Ian David Kaye; Mark Kurd; Alan S Hilibrand; Alexander R Vaccaro; Gregory D Schroeder; Christopher K Kepler

doi:10.1016/j.wneu.2023.06.039

Perioperative Dexamethasone Does Not Reduce Postoperative Opioid Use Following Anterior Cervical Discectomy and Fusion

World Neurosurg. 2023 Jun 20:S1878-8750(23)00807-0. doi: 10.1016/j.wneu.2023.06.039. Online ahead of print.

Authors

Yunsoo Lee¹, Tariq Ziad Issa², Teeto Ezeonu², Aditya Mazmudar², Mark J Lambrechts², Richard Padovano², Eric DiDomenico², Patrick O'Connor², Sebastian I Fras², John J Mangan², Giovanni Grasso³, Jose A Canseco², Ian David Kaye², Mark Kurd², Alan S Hilibrand², Alexander R Vaccaro², Gregory D Schroeder², Christopher K Kepler²

Affiliations

¹ Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. Electronic address: yunsoo.lee@rothmanortho.com.
² Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
³ Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.

PMID: 37343675
DOI: 10.1016/j.wneu.2023.06.039

Abstract

Objective: To determine if dexamethasone administration reduced narcotic consumption during hospitalization and to evaluate if patients who received dexamethasone refilled fewer opioid prescriptions postoperatively.

Methods: All adult patients who underwent primary elective 1- to 4-level anterior cervical discectomy and fusion at a single center were retrospectively identified. Prescription opioid use was collected from governmental online prescription drug monitoring programs, and in-hospital opioid use was collected from each patient's medication administration record and recorded as morphine milligram equivalents (MMEs). Patients were categorized by whether or not intravenous dexamethasone was administered perioperatively. Dexamethasone protocols were considered high dose if weight-based dosing was >0.20 mg/kg and low dose if <0.20 mg/kg. Multivariable linear regression was conducted to assess the relationship between dexamethasone administration and MMEs prescribed at each time point while accounting for confounders.

Results: Of 249 included patients, 167 (67%) were administered dexamethasone. Patients in both groups used a similar quantity of opioids while hospitalized (no dexamethasone: 56.7 MMEs/day vs. dexamethasone: 39.4 MMEs/day, P = 0.350). Patients in both groups refilled a similar quantity of opioids in all postoperative time periods: 0-3 weeks (3.38 vs. 4.07 MMEs/day, P = 0.528), 3-6 weeks (0.36 vs. 0.75 MMEs/day, P = 0.198), 6-12 weeks (0.53 vs. 0.75 MMEs/day, P = 0.900), and 3 months to 1 year (0.28 vs. 0.43 MMEs/day, P = 0.531). On multivariable linear regression, dexamethasone was not associated with a reduction in opioid volume at any time point (all P > 0.05).

Conclusions: Administration of perioperative dexamethasone does not reduce in-hospital or home opioid usage regardless of weight-based dose. Analgesia should not be the primary driver of dexamethasone administration for anterior cervical discectomy and fusion.

Keywords: Analgesia; Anterior cervical discectomy and fusion; Cervical spine; Dexamethasone; Opioids; Steroids.