Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan.
Pain Physician. 2021 Jan;24(1):E87-E93.
Glucocorticoids (GCs) are expected to inhibit the synthesis and release of proinflammatory cytokines, which induces local pain. Serious side effects or complications are considered rare with single-dose GC use. However, the amount of systemic absorption and the side effects induced by local GC injections are not well understood.
We measured the changes in glucose levels after single-does dexamethasone injection with nerve blockade using a continuous glucose monitoring system (CGMS) in non-diabetes mellitus (DM) patients and investigated the risk factors for hyperglycemia.
This is a cohort study.
This study was conducted at Gifu University Hospital in Japan.
Forty-six non-DM patients who underwent elective lumbar or sacral nerve root pulsed radiofrequency or lumbar medial branch of the posterior primary rami conventional radiofrequency with dexamethasone (0.1 mg/kg) were analyzed. The patients underwent monitoring of their interstitial glucose using a CGMS. Hyperglycemia was defined as a blood glucose level >= 200 mg/dL. The area under the curve (AUC) where the blood glucose level was over 200 mg/dL was calculated and analyzed. The risk factors of hyperglycemia were determined using an applied ordinal regression model analysis with the AUC as the objective variable and 4 factors (age, body mass index, glucose level just before GC injection, and glycosylated hemoglobin) as explanatory variables. The blood glucose levels were predicted by a nonlinear regression model.
The AUC and maximum glucose level were higher on the first day than after the second day. None of the 4 factors were predictors of hyperglycemia. The glucose level before the procedure was associated with the predicted blood glucose level on the first day (P = 0.042). However, the 95% upper confidence limit of the maximum predicted blood glucose level was less than the safety margin. The predicted blood glucose levels returned to the usual level after the second day.
First, GCs are metabolized by cytochrome p450 3A4, and it is possible that the inhibition of this pathway decreases the clearance of GCs. Some of our patients were taking medications that influence this cytochrome pathway. Second, we cannot eliminate the possibility of stress-induced hyperglycemia. Finally, we were unable to record the exact meal timing and calories the patients had consumed.
The blood glucose levels were higher than usual on the first day following a local dexamethasone injection, but the levels were not critical in most cases. Because we cannot predict which patients will develop hyperglycemia, we must determine whether or not GCs can be safely administered and inform patients about potential complications.
糖皮质激素（GCs）预计会抑制促炎细胞因子的合成和释放，从而引发局部疼痛。单次使用 GC 被认为很少出现严重的副作用或并发症。然而，局部 GC 注射引起的全身吸收量和副作用还没有被很好地了解。
我们使用连续血糖监测系统（CGMS）测量非糖尿病（DM）患者单次使用地塞米松神经阻滞注射后的血糖变化，并研究发生高血糖的危险因素。
这是一项队列研究。
日本岐阜大学医院。
分析了 46 例接受选择性腰椎或骶神经根脉冲射频或腰椎内侧支后路初级分支常规射频治疗并注射地塞米松（0.1mg/kg）的非 DM 患者。患者使用 CGMS 监测间质葡萄糖。高血糖定义为血糖水平>=200mg/dL。计算并分析血糖水平超过 200mg/dL 的曲线下面积（AUC）。使用应用有序回归模型分析，将 AUC 作为因变量，4 个因素（年龄、体重指数、GC 注射前血糖水平和糖化血红蛋白）作为解释变量，确定高血糖的危险因素。使用非线性回归模型预测血糖水平。
第 1 天的 AUC 和最大血糖水平高于第 2 天。4 个因素均不是高血糖的预测因素。手术前的血糖水平与第 1 天的预测血糖水平相关（P=0.042）。然而，最大预测血糖水平的 95%上限置信区间小于安全裕度。第 2 天后预测的血糖水平恢复到正常水平。
首先，GC 由细胞色素 p450 3A4 代谢，抑制该途径可能会降低 GC 的清除率。我们的一些患者正在服用影响该细胞色素途径的药物。其次，我们不能排除应激诱导性高血糖的可能性。最后，我们无法记录患者确切的用餐时间和摄入的卡路里。
局部注射地塞米松后第 1 天的血糖水平高于正常水平，但在大多数情况下，血糖水平没有达到危急值。由于我们无法预测哪些患者会发生高血糖，因此我们必须确定 GC 是否可以安全给药，并告知患者潜在的并发症。
