Local Retropharyngeal Space Anesthetic for Dysphagia Reduction after Anterior Cervical Discectomy and Fusion Surgery: A Single-Center, Prospective, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

World Neurosurg. 2021 Feb:146:e1377-e1383. doi: 10.1016/j.wneu.2020.12.016. Epub 2020 Dec 11.

Abstract

Objective: The main objective of this study was to analyze the ability of local anesthetic instillation into the retropharyngeal space to reduce dysphagia symptoms and occurrence rates in patients undergoing anterior cervical discectomy and fusion (ACDF) procedures.

Methods: A single-center, prospective, randomized, double-blinded, and placebo-controlled clinical study was performed. We enrolled patients undergoing one- or two-level ACDF procedures for cervical degenerative disc disease with disc herniation, radiculopathy and/or myelopathy symptoms. The patients were randomly assigned (1:1 ratio) to receive either 0.5% bupivacaine hydrochloride or 0.9% NaCl solution.

Results: Forty-three (74%) and 41 (77%) of patients reported dysphagia symptoms at the time of discharge in the investigational and control groups, respectively. There were no statistically significant differences in duration of dysphagia symptoms, Swallowing-Quality of Life (SWAL-QOL) survey or pain scores between the investigational and control patient groups at any of the follow-up time points. Controlling for independent variables, only younger age significantly predicted dysphagia symptoms at discharge, 2-week, and 3-month follow-ups (P ≤ 0.03; R ≥ -0.038; OR 0.96, 95% CI 0.93-0.99. Female sex was associated with lower SWAL-QOL scores at discharge (P = 0.046; R = 0.87; OR 2.38, 95% CI 1.02-5.56). A total of 8 (13.8%) and 6 (11.3%) patients in the investigational and control groups, respectively, were referred to a specialist or underwent speech therapy for their dysphagia symptoms. There were no adverse reactions to the study drug observed.

Conclusions: Local retropharyngeal space anesthetic instillation did not reduce dysphagia symptoms or occurrence rates in patients undergoing anterior discectomy and fusion surgeries.

Keywords: Anterior cervical discectomy and fusion; Bupivacaine hydrochloride; Dysphagia; Prospective randomized trial; Spine surgery.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Anesthetics, Local / therapeutic use*
  • Bupivacaine / therapeutic use
  • Cervical Vertebrae / surgery*
  • Deglutition Disorders / epidemiology
  • Deglutition Disorders / physiopathology
  • Deglutition Disorders / prevention & control*
  • Diskectomy / methods*
  • Double-Blind Method
  • Female
  • Humans
  • Intervertebral Disc Degeneration / complications
  • Intervertebral Disc Degeneration / surgery*
  • Intervertebral Disc Displacement / complications
  • Intervertebral Disc Displacement / surgery*
  • Male
  • Middle Aged
  • Pharynx*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / physiopathology
  • Postoperative Complications / prevention & control*
  • Quality of Life
  • Radiculopathy / etiology
  • Radiculopathy / surgery
  • Spinal Cord Compression / etiology
  • Spinal Cord Compression / surgery
  • Spinal Fusion / methods*

Substances

  • Anesthetics, Local
  • Bupivacaine