Adults commonly undergo lumbar spine surgery for conditions such as fractures, herniations, tumors, spinal stenosis, degenerative disc disease, and spondylolisthesis. Surgical spine procedures can be one of the most painful operative treatments that a patient undergoes due to the extensive tissue manipulation, muscle retraction, and the substantial number of implants required for adequate fixation. These procedures necessitate significant analgesia for adequate control of pain. Traditionally postoperative pain is treated with opioids but they are associated with range of adverse effects. Recently efforts have been promoted to reduce opioid consumption and their associated adverse effects like nausea, vomiting, urinary retention, constipation, respiratory depression.

Opioid alternatives include acetaminophen, NSAIDs, COX-2 specific inhibitors, gabapentin, local anaesthetics, dexamethasone, alpha 2 agonists and ketamine.

In our study we are using combination of above 2 drugs for opioid sparing effect. They are dexamethasone and Dexmedetomidine.

Dexamethasone (Dexa) is a glucocorticoid with a well-established analgesic and anti- emetic properties and suppresses the tissue levels of bradykinin. Inhibition of phospholipase which plays an essential role in the inflammatory chain reaction of both cyclooygenase and lipooxygenase pathway majorly contribute towards analgesic effect of dexamethasone.

Dexmedetomidine (Dex) make up the alpha-2 adrenergic receptor agonists which have been widely used as a target for medical conditions such as pain disorders, hypertension, ADHD (attention deficit hyperactivity disorder), and illicit drug use withdrawal symptoms. In recent years, alpha-2 agonists have been used as adjuncts for sedation and anesthetic use while partially blocking withdrawal symptoms in chronic opioid user. Dexmedetomidine activates α2-AR in the spinal cord reducing transmission of nociceptive signals like substance P. It has significant opioid sparing effect and is useful in intractable neuropathic pain. This advantage has made these drugs emerge as a new and effective analgesic for surgical spine patients.