Introduction: Postoperative dexamethasone is effective in relieving common adverse effects of anterior cervical discectomy and fusion (ACDF) including dysphagia and odynophagia. However, no studies have evaluated dexamethasone's effects on post-operative opioid use following ACDF. Our primary objective was to determine whether dexamethasone administration reduced pain medication administration during hospitalization. We secondarily sought to evaluate if patients who receive dexamethasone refill less postoperative opioids in the short-term and long-term post-operative period.
Methods: We retrospectively identified all patients undergoing 1- to 4-level primary elective ACDF at a single center from 2017-2021. Patients were grouped based on whether or not they received dexamethasone and by administered dose. In-hospital dexamethasone and opioid administration was collected from each patient’s medication administration record within our hospital’s electronic medical record system. Prescription data was collected from our states’ prescription drug monitoring program. Narcotic doses were then standardized to milligrams of morphine equivalents (MME). Bivariate analysis was performed comparing dexamethasone groups followed by multivariable linear regression to assess the relationship between dexamethasone administration and the amount of MME prescribed at each time point.
Results: We included 249 patients, 167 (67.1%) of whom were administered dexamethasone. Following their procedure, patients in both groups utilized a similar quantity of as needed opioid medications while hospitalized (no dexamethasone: 56.7 ± 49.3 vs. dexamethasone: 39.4 ± 45.6 MME/day, p=0.3499). We also found that patients in both groups refilled a similar quantity of opioids in all postoperative time periods; 0-3 week (3.38 ± 3.13 vs. 4.07 ± 4.50 MME/day, p = 0.5277), 3-6 week (0.36 ± 1.07 vs. 0.75 ± 1.90 MME/day, p=0.1979), 6-12 week (0.53 ± 1.24 vs. 0.75 ± 1.80 MME/day, p=0.9000), and 3-month to one-year (0.28 ± 0.77 vs. 0.43 ± 1.13 MME/day, p=0.5310). On multivariable linear regression, dexamethasone was not associated with a reduction in opioid volume at any time point (all p>0.05).
Conclusion : Post-operative dexamethasone does not adequately provide patient analgesia and reductions in post-operative narcotic use following ACDF. While dexamethasone may provide other benefits following cervical spine surgery, other agents should be incorporated in multimodal analgesia protocols in order to optimize patient outcomes and reduce short- and long-term postoperative opioid consumption.
