神经周围注射糖皮质激素对全髋关节置换术患者空腹血糖、血钾及白细胞计数的全身影响

Systemic Effects of Perineural Glucocorticoids on Fasting Serum Glucose, Potassium, and White Blood Cell Count in Total Hip Arthroplasty.

作者信息

Sharma Avijit, Dai Feng, Tseng Lanya, Effraim Philip R, Zhou Bin, Schonberger Robert B, Li Jinlei

机构信息

Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.

Yale Center for Analytical Sciences, Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA.

出版信息

J Pain Res. 2023 Feb 18;16:553-561. doi: 10.2147/JPR.S395336. eCollection 2023.

DOI:10.2147/JPR.S395336

PMID:36846205

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9946012/

Abstract

PURPOSE

Glucocorticoids are commonly used as regional anesthesia adjuvants to improve blockade quality and duration. There are limited data in the literature regarding the potential systemic effects and safety of perineural glucocorticoids. This study examines the effects of perineural glucocorticoids on serum glucose, potassium, and white blood cell count (WBC) in the immediate postoperative period after primary total hip arthroplasty (THA).

PATIENTS AND METHODS

A retrospective cohort study was carried out at a tertiary academic medical center utilizing electronic health records of 210 patients who underwent THA, for which patients received either a periarticular local anesthetic injection alone (PAI, N=132) or additional peripheral nerve blocks (PNB, N=78) containing 10 mg dexamethasone and 80 mg methylprednisolone acetate (PAI+PNB). The primary outcome was change in serum glucose from a preoperative baseline on postoperative days (POD) 1, 2, and 3. Secondary outcomes included changes in WBC and serum potassium.

RESULTS

The change in serum glucose from baseline was found to be significantly higher in the PAI+PNB group compared to the PAI group on POD 1 (mean difference 19.87 mg/dL, 95% CI [12.42, 27.32]; <0.001) and POD 2 (mean difference 17.5 mg/dL, 95% CI [9.66, 25.44], <0.001). No significant difference was found on POD 3 (mean difference -8.18 mg/dL, 95% CI [-19.07, 2.70], =0.14). Statistically significant but clinically insignificant differences were detected in serum potassium in the PAI+PNB group compared to the PAI group on POD1 (mean difference 0.16 mEq/L, 95% CI [0.02, 0.30], =0.03) and WBC on POD 2 (mean difference 3.18 × 1000/mm, 95% CI [2.14, 4.22], <0.001).

CONCLUSION

Patients who underwent THA and received PAI+PNB with glucocorticoid adjuvants demonstrated higher elevations in serum glucose for the first two PODs compared to patients who received PAI alone. These differences resolved by a third POD and are likely to be of no clinical significance.

摘要

目的

糖皮质激素常用作区域麻醉佐剂，以提高阻滞质量和持续时间。关于神经周围使用糖皮质激素的潜在全身影响和安全性，文献中的数据有限。本研究探讨了在初次全髋关节置换术（THA）术后即刻，神经周围使用糖皮质激素对血清葡萄糖、钾和白细胞计数（WBC）的影响。

患者与方法

在一家三级学术医疗中心进行了一项回顾性队列研究，利用210例行THA患者的电子健康记录，这些患者要么仅接受关节周围局部麻醉注射（PAI，n = 132），要么接受额外的包含10 mg地塞米松和80 mg醋酸甲泼尼龙的外周神经阻滞（PNB，n = 78）（PAI + PNB）。主要结局是术后第1、2和3天血清葡萄糖相对于术前基线的变化。次要结局包括WBC和血清钾的变化。

结果

发现PAI + PNB组术后第1天（平均差异19.87 mg/dL，95%CI[12.42，27.32]；<0.001）和第2天（平均差异17.5 mg/dL，95%CI[9.66，25.44]，<0.001）血清葡萄糖相对于基线的变化显著高于PAI组。第3天未发现显著差异（平均差异 - 8.18 mg/dL，95%CI[-19.07，2.70]，P = 0.14）。与PAI组相比，PAI + PNB组术后第1天血清钾（平均差异0.16 mEq/L，95%CI[0.02，0.30]，P = 0.03）和术后第2天WBC（平均差异3.18×1000/mm，95%CI[2.14，4.22]，<0.001）检测到具有统计学意义但临床意义不显著的差异。