Dexamethasone Perioperative Coanalgesia in Lumbar Spine Fusion

PURPOSE: A 48-hour trial of dexamethasone coanalgesia became our standard practice in May 2008. This is our research Ethics Board-approved review of this experience to date with attention to perioperative narcotics use and pain scores for the first 48 hours after surgery as well as length of stay (LOS), wound healing complications, and infections in the first 6 months, compared with the historical precedent control cohort. METHODS: Surgical case logs identified cases of 1- and 2-level elective lumbar decompression and fusion surgery performed since protocol initiation (cases) and for a like period beforehand (controls). Minimum of 6 months follow-up (sufficient to identify acute and subacute wound healing problems and perioperative infections) information was required. Hospital, Pain Service, and office records were reviewed for the extraction of outcomes data. RESULTS: We identified 132 cases and 146 controls. In 41 additional cases records were deficient. Baseline characteristics were equivalent. Cases included 70 males (53%) and 62 females (47%) of mean age 54 years (range, 18-84 y). Seventy-five (57%) cases were narcotics dependant (mean of 79.5 mg-morphine-equivalent daily). Controls included 78 males (53%) and 68 females (47%) of mean age 55 years (range, 27-85 y). Eighty-nine (61%) controls were narcotics dependant (mean 101.2 mg-morphine-equivalents daily). Mean morphine-equivalents narcotic consumption for 48 hours after surgery was 262.9 mg in cases and 280.7 mg in controls. VAS pain scores at 48 hours after surgery averaged 4.4 and 6.9 during rest and activity in the cases, and 3.7 and 6.3 during rest and activity in the controls. LOS averaged 3.9 days in cases and 5.2 days in controls. Delayed wound healing and surgical site infections were not observed in either group. CONCLUSIONS: Systemic dexamethasone after 1- and 2-level lumbar fusion surgery demonstrated minimal impact on 48 hours perioperative narcotics use with no detriment to pain control, wound healing, or infections. LOS was shortened by 25%.