Department of Orthopaedics, Thammasat Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Clin Orthop Surg. 2022 Jun;14(2):253-262. doi: 10.4055/cios21139. Epub 2022 May 13.
The efficacy of preoperative dexamethasone in anterior cervical discectomy and fusion (ACDF) to reduce dysphagia and odynophagia remains controversial. This study evaluated the effect of a single dose of intravenous dexamethasone given as preemptive analgesia in the ACDF procedure.
A total of 64 patients aged 18 years or over were randomized into two groups. The experimental group received dexamethasone 10 mg intravenously before surgery for 60 minutes, and the control group received normal saline. One surgeon operated on all patients. The Bazaz score and visual analog scale (VAS) for odynophagia were measured at 0 hour, 24 hours, 48 hours, 72 hours, and 2 weeks postoperatively. Prevertebral soft-tissue swelling (PSTS) and the modified Japanese orthopedic association (mJOA) score were measured preoperatively and 2 weeks postoperatively.
The Bazaz scores at 0, 24, 48, and 72 hours after operation were significantly lower in the dexamethasone group than in the placebo group ( < 0.001, < 0.001, < 0.001, and = 0.004, respectively). The VAS scores of the dexamethasone group were significantly lower than those of the placebo group at 0, 24, 48, and 72 hours after surgery (all < 0.001), but there was no significant reduction in the Bazaz score and VAS score at 2 weeks postoperatively. There was no difference in PSTS and mJOA preoperatively and 2 weeks postoperatively.
A single dose of intravenous dexamethasone used preoperatively in single-level and multilevel ACDF can significantly improve symptoms of dysphagia and odynophagia early on postoperatively.
术前地塞米松在颈椎前路椎间盘切除融合术（ACDF）中减少吞咽困难和咽喉痛的疗效仍存在争议。本研究评估了作为预防性镇痛在 ACDF 手术中给予单剂量静脉地塞米松的效果。
共纳入 64 名年龄在 18 岁及以上的患者，随机分为两组。实验组在手术前静脉给予地塞米松 10mg，持续 60 分钟，对照组给予生理盐水。所有患者均由同一位外科医生进行手术。在术后 0 小时、24 小时、48 小时、72 小时和 2 周时，使用 Bazaz 评分和咽喉痛视觉模拟量表（VAS）进行评估。术前和术后 2 周测量椎前软组织肿胀（PSTS）和改良日本骨科协会（mJOA）评分。
术后 0、24、48 和 72 小时，地塞米松组的 Bazaz 评分明显低于安慰剂组（均 <0.001）。地塞米松组的 VAS 评分在术后 0、24、48 和 72 小时均明显低于安慰剂组（均 <0.001），但术后 2 周时 Bazaz 评分和 VAS 评分无明显降低。术前和术后 2 周 PSTS 和 mJOA 无差异。
在单节段和多节段 ACDF 中，术前单次静脉使用地塞米松可显著改善术后早期吞咽困难和咽喉痛症状。
