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Post-operative steroids in patients with patients with severe cerebral palsy undergoing posterior spinal fusion
Tracy Ruska1, Thomas M Austin2, Robert W Bruce1
1Department of Orthopaedic Surgery, Clinical Practice Group, Children's Healthcare of Atlanta, 1400 Tullie Rd NE, Atlanta, GA, 30329, USA.
Insights
Post-operative steroids significantly reduced pain medication needs in pediatric patients undergoing posterior spinal fusion for neuromuscular scoliosis. This approach did not increase complications, offering a promising option for pain management.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Pharmacology
Background:
- Posterior spinal fusion (PSF) for neuromuscular scoliosis (NMS) presents significant perioperative challenges, particularly concerning post-operative pain and immobilization.
- Complications are common, impacting patient recovery and hospital stay.
Purpose of the Study:
- To evaluate the impact of post-operative steroid administration on pain management and complications in pediatric patients undergoing PSF for NMS.
- To assess the effect of steroids on opioid consumption and patient outcomes.
Main Methods:
- A retrospective review of 89 pediatric patients who underwent PSF for NMS was conducted.
- Patients were divided into two groups: those who received post-operative steroids (dexamethasone) and those who did not.
- Clinical and radiographic data were analyzed, focusing on post-operative pain, complications, and length of stay.
Main Results:
- Patients receiving post-operative steroids (dexamethasone) showed a 70% decrease in median morphine equivalent use compared to the non-steroid group (0.50 mg/kg vs 1.65 mg/kg).
- A correlation was found between higher post-operative morphine use and increased length of stay.
- No significant differences were observed in wound healing, infection rates, pulmonary or gastrointestinal complications, or 30-day return visits between the groups.
Conclusions:
- Post-operative dexamethasone administration effectively reduces opioid requirements after PSF for NMS.
- Steroid use in this context did not lead to an increase in adverse perioperative events, including wound infections.
- Steroids represent a viable adjunct for pain management in pediatric NMS patients undergoing spinal fusion.
Introduction:
Posterior spinal fusion (PSF) represents a large physiologic challenge for children with neuromuscular scoliosis (NMS). Perioperative complications are numerous with many occurring in the post-operative period due to pain and relative immobilization. This study assessed the impact of steroids on patients undergoing PSF for NMS.
Methods:
A retrospective review of consecutive patients managed at a single center with PSF for NMS was reviewed. Clinical and radiographic analysis was used to evaluate baseline demographics, curve characteristics, and post-operative course.
Results:
Eighty-nine patients who underwent PSF for NMS were included. Fifty-seven of these patients did not receive post-operative steroids (NS) while 32 patients were treated with post-operative steroids (dexamethasone, WS) for a median of 3 doses (median 6.0 mg/dose every 8 h after surgery). The demographic variables of the cohorts were similar with no difference in curve magnitude, number of vertebrae fused, number of osteotomies, or EBL between groups. A 70% decrease in the median post-operative morphine equivalents was observed in the steroid cohort (0.50 mg/kg WS vs 1.65 mg/kg NS, p value < 0.001). There was an association between post-operative morphine equivalents and length of stay (Spearman's rho = 0.22, p value = 0.04). There was no difference in wound healing, infection, and pulmonary or gastrointestinal complications between groups. No difference was found in pain at discharge, 30-day ED returns, or 30-day OR returns between groups.
Conclusions:
Post-operative dexamethasone resulted in a 70% decrease in morphine equivalent use after PSF for NMS without any increase in perioperative wound infections.
Level Of Evidence:
Level 3: case-control series.
