Steroids after spine fusion may decrease opioid use
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Patients with adolescent idiopathic scoliosis who received a short course of postoperative steroids after posterior spinal fusion had decreased opioid use and no increase in wound complications, according to published results.
Nicholas D. Fletcher, MD, medical director of Spine Quality and Outcomes at Children’s Healthcare of Atlanta, and colleagues reviewed demographic characteristics, curve characteristics, surgical data and postoperative clinic notes of 113 patients with adolescent idiopathic scoliosis who either did (n=48) or did not (n=65) receive three doses of postoperative steroids after posterior spinal fusion. Researchers converted all postoperative opioids given into morphine milligram equivalents to determine opioid usage.
Results showed no differences in curve magnitude, number of vertebrae fused or estimated blood loss between the groups. In the group that received postoperative steroids, researchers found a 39.6% and 29.5% decrease in total and weight-based morphine milligram equivalents used, respectively, a difference which persisted after accounting for gabapentin, ketorolac and diazepam usage, surgical time, curve size, levels fused and number of osteotomies.
Wound dehiscence requiring wound care developed in 4.6% of patients in the nonsteroid group and 8.3% of patients in the steroid group, according to results. Surgical debridement for the treatment of an infection occurred in one patient in the nonsteroid group, researchers noted. Researchers also found patients who received steroids were more likely to walk at the time of the initial physical therapy evaluation.
“The use of short-term perioperative corticosteroids has increased in many other areas of surgery; however, orthopedists have likely been reticent to use them because of concerns regarding healing and infection that has been perpetuated despite a lack of clinical evidence to support this notion,” Fletcher, associate professor of orthopedic surgery at Emory University School of Medicine, told Healio Orthopedics. “My hope is that this study brings awareness to the potential benefit of these inexpensive, generally well tolerated and widely accessible medications as a supplement to a multimodal pain protocol after orthopedic surgery.”
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Michael J. Heffernan, MD
This is a great contribution to our literature from Nicholas D. Fletcher, MD, and his team. In recent years at Children’s Hospital New Orleans, we have seen our average length of stay decrease from 4.5 days to 2.5 days with implementation of a rapid recovery protocol. One of the hallmarks of a successful rapid recovery protocol is a multimodal approach to pain control with minimization of opioid usage. The authors showed a significant decrease in opioid consumption with the use of dexamethasone in the postoperative period. Moreover, the rate of wound complications was not higher in the group that received steroids.
At first glance, I am hesitant about the use of steroids in the perioperative period. The number of patients in the study is relatively low and further investigation is needed. However, the findings of this study are certainly encouraging, and we will be discussing the potential benefits of adding dexamethasone to our institution’s protocol.
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