Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 18:16:553-561.
doi: 10.2147/JPR.S395336. eCollection 2023.

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

Avijit Sharma  1 , Feng Dai  2 , Lanya Tseng  1 , Philip R Effraim  1 , Bin Zhou  2 , Robert B Schonberger  1 , Jinlei Li  1
Affiliations

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

Avijit Sharma et al. J Pain Res. .

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]; P<0.001) and POD 2 (mean difference 17.5 mg/dL, 95% CI [9.66, 25.44], P<0.001). No significant difference was found on POD 3 (mean difference -8.18 mg/dL, 95% CI [-19.07, 2.70], P=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], P=0.03) and WBC on POD 2 (mean difference 3.18 × 1000/mm3, 95% CI [2.14, 4.22], P<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.

Keywords: fascia plane block; perineural dexamethasone; perineural glucocorticoid; perineural methylprednisolone acetate; serum glucose; total Hip arthroplasty.

PubMed Disclaimer

Conflict of interest statement

Dr. Schonberger reports owning stock in Johnson & Johnson and also reports that Merck, Inc. has provided support to Yale University for a study on which Dr. Schonberger is a co-investigator unrelated to the present work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of screened and excluded patients.
Figure 2
Figure 2
Absolute values and changes from baseline of glucose, potassium, and WBC count for the PAI and PAI+PNB groups before covariate adjustment. The data gathered for glucose, potassium and WBC values are displayed in panels (A–C), respectively. The left side of each panel displays data from the “Spinal with PAI” group and right side of each panel displays “Spinal with PAI+PNB” group. The absolute values for the preoperative, POD 1, POD 2 and POD 3 levels, and the change from preoperative baseline values for POD1, 2, and 3 are also shown.
Figure 3
Figure 3
Trends of changes of postoperative laboratory values after covariate adjustment in the regression model with preoperative baseline values, time, group, and time by group interaction. Postoperative value changes compared to baseline for fasting serum glucose (A), potassium (B) and WBC (C) are displayed.
See this image and copyright information in PMC

References

    1. Kirkham KR, Jacot-Guillarmod A, Albrecht E. Optimal dose of perineural dexamethasone to prolong analgesia after brachial plexus blockade: a systematic review and meta-analysis. Anesth Analg. 2018;126(1):270–279. doi:10.1213/ANE.0000000000002488 - DOI - PubMed
    1. An K, Elkassabany NM, Liu J. Dexamethasone as adjuvant to bupivacaine prolongs the duration of thermal antinociception and prevents bupivacaine-induced rebound hyperalgesia via regional mechanism in a mouse sciatic nerve block model. PLoS One. 2015;10(4):e0123459. doi:10.1371/journal.pone.0123459 - DOI - PMC - PubMed
    1. Baeriswyl M, Kirkham KR, Jacot-Guillarmod A, Albrecht E. Efficacy of perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth. 2017;119(2):183–191. doi:10.1093/bja/aex191 - DOI - PubMed
    1. Zorrilla-Vaca A, Li J. Dexamethasone injected perineurally is more effective than administered intravenously for peripheral nerve blocks: a meta-analysis of randomized controlled trials. Clin J Pain. 2018;34(3):276–284. doi:10.1097/AJP.0000000000000519 - DOI - PubMed
    1. Hewson D, Bedforth N, McCartney C, Hardman J. Dexamethasone and peripheral nerve blocks: back to basic (science). Br J Anaesth. 2019;122(4):411–412. doi:10.1016/j.bja.2019.02.004 - DOI - PMC - PubMed