The 68th
Scientific Meeting
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| 19S-024 |
Relationship between epidural steroid dose and HPA axis suppression: a pilot study.
1. Department of
Anesthesiology and Pain Medicine, Yeouido St. Mary’s Hospital, College of Medicine,
The Catholic University of Korea
2. Department of
Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of
Medicine, The Catholic University of Korea
Background and objectives: Epidural steroid injections (ESI) are therapeutically useful for the treatment of herniated intervertebral discs and spinal stenosis. However, there is a lack of evidence-based data about its safety. In prior study, the hypothalamus-pituitary-adrenal (HPA) axis suppression could be measured by the salivary cortisol concentration changes.The aim of this study was to evaluate the difference of the duration of HPA axis suppression after a single epidural injection of 20mg/40mg of triamcinolone.
Methods: This double-blinded, randomized controlled trial pilot study included 30 patients with lumbar intervertebral disc herniation or spinal stenosis. Patients were randomly divided into two groups of triamcinolone 20mg (15 patients) and triamcinolone 40mg (15 patients). Early morning salivary cortisol concentrations were assessed Day 0 (pre-ESI), Day 1 (post-ESI), 7, 14, 21, and 28. Additionally, numeric rating scale (NRS), ACTH stimulation test, and serum ACTH levels were evaluated.
Results: The result show that there was significant difference in mean period of HPA axis suppression (salivary cortisol < 0.1 dL) after ESI. The mean period of HPA axis suppression was observed in triamcinolone 20mg group for 8.04 ± 2.37 days after ESI, and in triamcinolone 40mg group for 19.69 ± 3.14 days (p value < 0.01). However, there is was difference in the incidence of adrenal insufficiency between both groups.
Conclusions: Mean period of HPA axis suppression after ESI was prolonged in proportion to the triamcinolone dose.
Methods: This double-blinded, randomized controlled trial pilot study included 30 patients with lumbar intervertebral disc herniation or spinal stenosis. Patients were randomly divided into two groups of triamcinolone 20mg (15 patients) and triamcinolone 40mg (15 patients). Early morning salivary cortisol concentrations were assessed Day 0 (pre-ESI), Day 1 (post-ESI), 7, 14, 21, and 28. Additionally, numeric rating scale (NRS), ACTH stimulation test, and serum ACTH levels were evaluated.
Results: The result show that there was significant difference in mean period of HPA axis suppression (salivary cortisol < 0.1 dL) after ESI. The mean period of HPA axis suppression was observed in triamcinolone 20mg group for 8.04 ± 2.37 days after ESI, and in triamcinolone 40mg group for 19.69 ± 3.14 days (p value < 0.01). However, there is was difference in the incidence of adrenal insufficiency between both groups.
Conclusions: Mean period of HPA axis suppression after ESI was prolonged in proportion to the triamcinolone dose.
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