Our next abstract, which was our second award winner, the presenting author is Brendan McShane. And are you a Mackel student? Research assistant. Research assistant, who is a research assistant. And Ms. Gardner was the advanced practice provider on the research. The title of the abstract is Low-Dose Steroid Use, Medrel Dose Pack. After lumbar laminectomy and or discectomy surgery to decrease post-operative pain in narcotic use. The author block was Diana Gardner, Marie Kerr, John Pierce, Prateek Argawal, Nicole Paseo, Stephen Dante, William Welch, Eileen Maloney-Wolensky. And Mr. McShane will present. Thank you. My name is Brendan McShane. I'm from the University of Pennsylvania at Pennsylvania Hospital. I'm here to discuss our research on the use of a low-dose steroid after lumbar laminectomy or discectomy to decrease post-operative pain and narcotic use. I'd like to thank the AANS for giving us the opportunity to talk and for honoring us with this award. And thank Diana Gardner for all the hard work she did on this study. We have no financial disclosures. Low back pain and sciatica are growing to become one of the world's leading causes of disability. Simultaneously, low back surgery has increased at a higher rate compared to other notable inpatient procedures. These common low back surgeries, such as lumbar laminectomy and lumbar discectomy, often result in significant post-operative pain. This is further complicated by pre-existing comorbidities. Effective post-operative pain control is crucial for facilitating early mobilization, expediting hospital discharge, and increasing patient satisfaction. To achieve this, opioids have routinely been used to decrease post-operative pain. However, in the recent decade, prescription painkillers have become a serious concern in the United States. Based on data from the CDC, opioid-related overdose deaths have more than tripled since 1990. Due to the growing concern of over-prescription of opioids, it is important that we continue to evaluate other methods of post-operative pain control. In the present study, we evaluated the potential relationship between taking a low-dose oral steroid and its effect on post-operative pain and opioid use. We hypothesized that an oral steroid would reduce inflammation at the surgical site and therefore reduce patient pain. This would reduce patient opioid use. In our study, we prospectively enrolled 140 patients undergoing lumbar laminectomy or discectomy at a single institution by one of two senior neurosurgeons. Patients were evenly assigned into an oral steroid group and a non-steroid group. All patients were prescribed a narcotic for them to use as needed after discharge. In the steroid group, a prescription or a medial dose pack was given to use along with their painkillers. Patients completed a preoperative VASC score at their history and physical visit. At this visit, they were also given a 10-day diary in which they were instructed to complete an average daily pain for 10 days after discharge as well as record their total medication use for each day. Surgical outcomes, 30-day narcotic use, and 30-day return to work status were also analyzed. We created a multivariate regression model with repeated measures to adjust for possible confounding variables. Additionally, a Fisher-Exak test was used to compare the two groups. 87 patients completed all study procedures and were used in our final analysis. 41 patients were enrolled in the medial dose pack group while 46 were in the non-medial dose pack group. And at baseline, there was no difference between the visual analog scores. We found that after discharge, there was a significant decrease in visual analog scores between the medial dose pack group and the non-medial dose pack group, with the medial dose pack reporting less pain. Additionally, Percocet use, or Percocet decreased visual analog scores in each day after discharge. There was no significant difference on visual analog scores for each attending. Total Percocet use did decrease significantly with each day after discharge and was found to be higher in patients who had higher pain. However, there was no significant difference between the medial dose pack group and the non-medial dose pack group in total Percocet use. At 30 days post-surgery, there was no difference in patient reporting of pain, narcotic use, or return to work status. Additionally, there was no difference in re-hospitalization rates between the two groups. In our study, the administration of a medial dose pack did decrease post-operative pain. However, it interestingly did not affect patient opioid consumption. This may suggest that patient use of pain medications is multidimensional and is influenced by multiple factors rather than just pain. We also found that the administration of a medial dose pack did not have any effect on 30-day outcomes because the medial dose pack did not have any effect on 30-day outcomes between the two groups. To our knowledge, this is the first study that looked at using a medial dose pack to reduce opioid consumption after spine surgery. With the rise in global spine surgeries and the growing opioid epidemic, we believe that it's beneficial to use an oral steroid to reduce post-operative pain. In future studies, we aim to evaluate how prescribing practices may affect opioid consumption. Furthermore, since a medial dose pack did decrease post-operative pain, we hope to examine whether this aids in early mobilization and faster return to full activity. Thank you.

Brendan McShane

University of Pennsylvania Hospital

low-dose steroid

lumbar laminectomy

discectomy surgery