Prophylactic Racemic Epinephrine in Anterior Cervical Discectomy and Fusion
Prophylactic Racemic Epinephrine in Anterior Cervical Discectomy and Fusion
Our double-blinded, randomized control trial will assess the effect of nebulized racemic
 epinephrine inpatients undergoing anterior cervical discectomy and fusion (ACDF) procedures.
 The investigators have had success in managing post-operative dysphagia in patients
 undergoing ACDF with the administration of this drug. Half of the participants will review
 nebulized epinephrine. The other half will receive placebo.
Based on data from the National Inpatient Sample from 2002-2012, patients undergoing elective
 primary ACDF, diagnosed with dysphagia (4% of total patients), had a two-fold increase in
 mean length of stay (4.03 compared to 1.56 days; p < 0.001) and a substantial increase in
 their total hospital charges (p < 0.001) versus those not diagnosed with dysphagia. There are
 very few level I studies which describe successful management of these complications.
 Steroids have shown promise, however, there exist concerns for consequent delayed bony
 fusion. Racemic epinephrine is a mixture of both the R and L isomers of epinephrine which
 theoretically results in a milder side effect profile and longer shelf-life versus the
 standard L-epinephrine. Traditionally, racemic epinephrine has been administered in a
 nebulized form for the treatment of severe asthma, laryngeal edema, and bronchiolitis. The
 most severe side effects that have been reported include tachyarrhythmias and paradoxical
 bronchospasms, although these reports are rare and limited mainly to single case reports or
 case series. It confers its therapeutic effect through Racemic α-adrenergic and β-adrenergic
 mediated vasoconstriction of mucosal vasculature decreasing edema and in the respiratory
 tract, inducing bronchodilation. The PI, has been utilizing nebulized racemic epinephrine at
 standard dosages (1 unit of 0.5 ml of 2.25% racemic epinephrine) for the treatment of severe
 post-operative dysphagia in patients undergoing ACDF for 20 years. The investigator has
 achieved marked success with this intervention with no notable associated complications.
 Despite being successfully utilized in this manner for many years in small pockets of the
 spine community, the use of prophylactic racemic epinephrine for the management of dysphagia
 has not been described in the literature. The investigators hope to be able to fill this
 important knowledge-gap with our study data.
Inclusion Criteria:

 1. Patients > 18 years of age

 2. Primary two and three-level ACDF between C3-7

 3. Approved pre-authorization to undergo the procedure

 Exclusion Criteria:

 1. Patients < 18 years of age

 2. Patients who are unable to give their own consent

 3. Revision ACDF

 4. Combined anterior-posterior surgeries

 5. Surgeries involving C2-C3 or C7-T1

 6. Surgeries related to trauma, infection, or tumor

 7. Patients with baseline swallowing dysfunction

 8. Patients currently on steroids

 9. Patients with severe cardiac disease

 10. Uncontrolled diabetics as defined by patients with a HbA1C > 8%

 11. Patients with known allergy to epinephrine