Corticosteroids in regional anaesthesia and analgesia – state of the art
Authors:
J. Lejčko 1; T. Gabrhelík 2,3
Authors‘ workplace:
Centrum pro léčbu bolesti, Klinika anesteziologie, resuscitace a intenzivní medicíny, Lékařská fakulta v Plzni a Fakultní nemocnice Plzeň, Univerzita Karlova
1; Oddělení anesteziologie, resuscitace a intenzivní medicíny, Krajská nemocnice Tomáše Bati, a. s.
2; Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice a Lékařská fakulta Univerzity Palackého v Olomouci
3
Published in:
Anest. intenziv. Med., 29, 2018, č. 3, s. 151-157
Category:
Review Article
Overview
Optimisation of postoperative pain control plays an important role in the outcome of surgery. Various adjuncts have been studied in an attempt to enhance the effect of single injection local anaesthetic peripheral nerve blockade, with varying results. Perineural steroids appear to prolong the duration of analgesia after peripheral nerve blockade with local anaesthetics. Other benefits include decreased perioperative opioid use and nausea. The largest number of data is about dexamethasone. However, corticosteroids are not currently licensed for perineural use in Europe and USA. In spite of the fact, the drug is still widely used for this unlicensed indication. Nowadays, spinal epidural steroid injection is the most used interventional pain practice in the management of both neck pain and low back pain. It is a useful technique in pain management of herniated discs, radicular pain and spinal stenosis. Targeted steroid application to the point of pain origin may be beneficial, providing short-term or medium-term effect. Proper patient selection and timing of the procedure are essential for adequate pain relief. Serious adverse effects of corticosteroid injection are rare but can be fatal. Principles of safe spinal interventional procedures have to be adhered to. In order to reduce the rate of fatal complications we recommend using non-particulate steroids and giving a test dose first. Real-time imaging is necessary during every single spinal steroid injection.
keywords:
perineural administration of corticosteroids – dexamethasone – spinal injection – back pain – safety – diagnostic study
Sources
1. Lievre JA, Bloch-Michel H, Pean G. L’hydrocortisone en injection locale. Rev Rheum. 1953;20:310.
2. Schilling LS, Markman JD. Corticosteroids for Pain of Spinal Origin: Epidural and Intraarticular Administration. Rheum Dis Clin North Am. 2016;42:137−155.
3. Albrecht E, Kern C, Kirkham KR. A systematic review and meta-analysis of perineural dexamethasone for peripheral nerve blocks. Anaesthesia. 2015;70:71−83.
4. Hyunh TM, Marret E, Bonnet F. Combination of dexamethasone and local anaesthetic solution in peripheral nerve blocks: A meta-analysis of randomised controlled trials. Eur J Anaesthesiol. 2015;32:751−758.
5. Choi S, Rodseth R, McCartney CJ. Effects of dexamethasone as a local anaesthetic adjutant for brachial plexus block: a systematic review and meta-analysis of randomised trials. Br J Anaesth. 2014;112:427−439.
6. Knezevic NN, Anantamongkol U, Candido KD. Perineural dexamethasone added to local anesthesia for brachial plexus block improves pain but delays block onset and motor blockade recovery. Pain Physician. 2015;18:1−14.
7. Liu J, Richman KA, Grodofsky SR, et al. Is there a dose response of dexamethasone as adjutant for supraclavicular brachial plexus block? A prospective randomized double-blinded clinical study. J Clin Anesth. 2015;27:237−242.
8. Wiesmann T, Volk T, Steinfeldt T. Glucocorticoids as an adjunct in peripheral regional anesthesia. Move to the „Holy grail of perineural analgesia“?! Anaesthesist. 2016;65:295–298.
9. Rosenfeld DM, Ivancic MG, Hattrup SJ, et al. Perineural versus intravenous dexamethasone as adjuncts to local anaesthetic brachial plexus block for shoulder surgery. Anaesthesia. 2016;71:380−388.
10. Chong MA, Berbenetz NM, Lin C, et al. Perineural versus intravenous dexamethasone as an adjuvant for peripheral nerve blocks: A systematic review and meta-analysis. Reg Anesth Pain Med. 2017;42:319−326.
11. Marty P, Bennis M, Legaillard B, et al. A new step toward evidence of in vivo perineural dexamethasone safety: an animal study. Reg Anesth Pain Med. 2017; Ap7 7. Doi 10.1097/AAP 0000000000000392. [Epub ahead of print]
12. Manchikanti L, Boswell MV, Singh V, et al. ASIPP-IPM. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 2009;12:699−802.
13. Diwan S, Manchikanti L, Benyamin RM, et al. Effectiveness of cervical epidural injections in the management of chronic neck and upper extremity pain. Pain Physician. 2012;15:405−434.
14. Manchikanti L, Buenaventura RM, Manchikanti KN, et al. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. 2012;15:199−245.
15. Cohen SP, Bicket MC, Jamison D, et al. Epidural steroids: a comprehensive, evidence-based review. Reg Anesth Pain Med. 2013;38:175−200.
16. Chou R, Hashimoto R, Friedly J, et al. Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163:373−381.
17. Liu J, Zhou H, Lu L, et al. The Effectiveness of Transforaminal Versus Caudal Routes for Epidural Steroid Injections in Managing Lumbosacral Radicular Pain: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2016;95:3373.
18. Manchikanti L, Cash KA, McManus CD, et al. A randomized, double-blind controlled trial of lumbar interlaminar epidural injections in central spinal stenosis: 2-year follow-up. Pain Physician. 2015;18:79−92.
19. Manchikanti L, Falco FJ, Pampati V, et al. Lumbar interlaminar epidural injections are superior to caudal epidural injections in managing lumbar central spinal stenosis. Pain Physician. 2014;17:691−702.
20. Manchikanti L, Nampiaparampil DE, Candido KD, et al. Do cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review. Pain Physician. 2015;18:39−60.
21. Manchikanti L, Atluri S. Lumbar epidural Nerve Block. In: Waldman SD. Pain Management. Philadelphia: Saunders Elsevier, 2007:1281−1293.
22. Neal JM, Bernards CM, Hadzic A, et al. ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med. 2008;33:404−415.
23. Dawley JD, Moeller-Bertram T, Wallace MS, et al. Intra-arterial injection in the rat brain: evaluation of steroids used for transforaminal epidurals. Spine. 2009;34:1638-1643.
24. Huntoon M. Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic injuries after transforaminal epidural injections. Pain. 2005;117:104−111.
25. Rathmell JP, Benzon HT, Dreyfuss P, et al. Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations. Anesthesiology. 2015;122:974−984.
26. El-Yahchouchi C, Geske JR, Carter RE, et al. The noninferiority of the nonparticulate steroid dexamethasone and triamcinolone in lumbar transforamial epidural steroid injections. Pain Med. 2013;14:1650−1657.
27. Lirk P, Kolbitsch C, Putz G, et al. Cervical and high thoracic ligamentum flavum frequently fails to fuse in the midline. Anesthesiology. 2003;99:1387−1390.
Labels
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2018 Issue 3
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