Brown-Beresford Kate, Wahba Medhat, Herriot Peter, Smithson-Tomas Georgia, Thiruvenkatarajan Venkatesan
Pain Management Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
Department of Anaesthesia, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
Interv Pain Med. 2022 May 5;1(2):100094. doi: 10.1016/j.inpm.2022.100094. eCollection 2022 Jun.
The purpose of the study was to review the cumulative corticosteroid doses received from epidural and non-epidural-based pain interventions in a cohort of patients undergoing epidural steroid injections (ESIs) with comparison to safe dosing recommendations.
Retrospective analysis was undertaken for all 349 patients who underwent a total of 581 ESIs at a single-centre, tertiary hospital in South Australia between 2017 and 2019. The primary outcome was the yearly dose analysis of cumulative steroid doses in methylprednisolone equivalents (MDPE) administered from epidural and non-epidural interventions in post-menopausal women, interpreted against maximum recommended doses.
The annual limit of 200 mg for postmenopausal women was exceeded in 4.7% of the time (11/235) from ESIs alone, with a significant rise to 15.3% (46/300) when non-ESI injections were included in cumulative dose totals(p < 0.001). Of the 173 participants of post-menopausal female age, 4.1% (7/173) received cumulative corticosteroid doses above the 3-year 400 mg MPDE limit from ESIs alone, with a statistically significant increase to 13.9% (24/173) when non-epidural steroid injections were again included in cumulative dose totals (p < 0.001). The mean ± standard deviation administered MPDE per epidural steroid injection across the whole study cohort was 72 ± 22 mg, nearly double the recommended dose of 40 mg.
Our study underpins the need for vigilance when considering steroid-based pain interventions, wherein both the individual and cumulative steroid exposure should be considered.
本研究的目的是回顾一组接受硬膜外类固醇注射（ESI）的患者从基于硬膜外和非硬膜外的疼痛干预措施中接受的累积皮质类固醇剂量，并与安全剂量建议进行比较。
对2017年至2019年期间在南澳大利亚一家单中心三级医院接受总计581次ESI的所有349例患者进行回顾性分析。主要结果是对绝经后妇女从硬膜外和非硬膜外干预措施中给予的甲基泼尼松龙等效物（MDPE）累积类固醇剂量进行年度剂量分析，并对照最大推荐剂量进行解读。
仅ESI时，4.7%（11/235）的时间超过了绝经后妇女每年200毫克的限量，当累积剂量总计中包括非ESI注射时，这一比例显著上升至15.3%（46/300）（p<0.001）。在173名绝经后女性年龄的参与者中，仅ESI时，4.1%（7/173）接受的累积皮质类固醇剂量超过了3年400毫克MPDE限量，当累积剂量总计中再次包括非硬膜外类固醇注射时，这一比例在统计学上显著增加至13.9%（24/173）（p<0.001）。整个研究队列中每次硬膜外类固醇注射给予的MPDE平均±标准差为72±22毫克，几乎是推荐剂量40毫克的两倍。
我们的研究强调了在考虑基于类固醇的疼痛干预措施时保持警惕的必要性，其中应同时考虑个体和累积类固醇暴露情况。
