The effect of preoperative dexamethasone on pain 1 year after lumbar disc surgery: a follow-up study

Rikke Vibeke Nielsen, Jonna Fomsgaard, Ole Mathiesen, Jørgen Berg Dahl, Rikke Vibeke Nielsen, Jonna Fomsgaard, Ole Mathiesen, Jørgen Berg Dahl

Abstract

Background: It has been hypothesized that dexamethasone can inhibit persistent postoperative pain, but data on humans is lacking and results from animal studies are conflicting. We explored the effect of 16 mg dexamethasone IV administered preoperatively on persistent pain 1 year after lumbar discectomy.

Methods: This is a prospective 1-year follow-up on a single-centre, randomized, and blinded trial exploring the analgesic effect of 16 mg IV dexamethasone or placebo after lumbar discectomy. One year follow-up was a written questionnaire including back and leg pain (VAS 0-100 mm), Short Form 36 survey (SF-36), EuroQol 5D (EQ-5D), OSWESTRY Low Back Pain Questionnaire, duration of sick leave, working capability, contentment with surgical result.

Results: Response rate was 71% (55 patients) in the dexamethasone group, 58% (44 patients) in the placebo group. Leg pain (VAS) was significantly lower in the placebo group compared to the dexamethasone group: 17 (95% CI 10-26) vs 26 (95% CI 19-33) mm, respectively (mean difference 9 mm (95% CI -1 to 0), (P = 0.03). No difference regarding back pain. The placebo group reported significantly more improvement of leg pain and were significantly more satisfied with the surgical result. Patients in the dexamethasone group reported significantly higher pain levels in EQ-5D- and Oswestry questionnaires. No difference in the SF-36 survey or daily analgesic consumption.

Conclusions: We found significantly higher pain levels in the dexamethasone group compared to placebo 1 year after lumbar disc surgery.

Trial registration: Clinicaltrials.gov ( NCT01953978 ). Registered 26 Sep 2013.

Keywords: Dexamethasone; Glucocorticoids; Persistent postoperative pain; Preemptive medicine; Spine surgery.

Figures

Fig. 1
Fig. 1
CONSORT flowchart of trial
Fig. 2
Fig. 2
Postoperative back- and leg pain (VAS). Leg pain 12 months postoperatively was significantly less in the placebo group compared to the dexamethasone group: 17 (95% CI 10–26) vs 26 (95% CI 19–33) mm, respectively, with a mean difference of 9 mm (95% CI −1 to 0), P = 0.033. There were no other significant differences between groups
Fig. 3
Fig. 3
Scatterplot of leg pain (VAS mm) 3- and 12 months postoperatively
Fig. 4
Fig. 4
EuroQol. Significant difference in severity of Pain/Discomfort with 28/67/5% in the dexamethasone group reporting no pain/moderate pain/severe pain respectively and in the placebo group 50/45/5% reported no pain/moderate pain/severe pain respectively, P = 0.034

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