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. 2022 May 5;1(2):100094.
doi: 10.1016/j.inpm.2022.100094. eCollection 2022 Jun.

Cumulative glucocorticoid exposure in patients receiving epidural steroid injections: A single-centre retrospective evaluation on 581 procedures against existing clinical recommendations

Kate Brown-Beresford  1   2 , Medhat Wahba  1   2 , Peter Herriot  1 , Georgia Smithson-Tomas  2 , Venkatesan Thiruvenkatarajan  2   3
Affiliations

Cumulative glucocorticoid exposure in patients receiving epidural steroid injections: A single-centre retrospective evaluation on 581 procedures against existing clinical recommendations

Kate Brown-Beresford et al. Interv Pain Med. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: Our study underpins the need for vigilance when considering steroid-based pain interventions, wherein both the individual and cumulative steroid exposure should be considered.

Keywords: Epidural pain interventions; Glucocorticoids; Non-epidural pain interventions; Postmenopausal women; Steroid dose exposure.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Single-Year Analysis from 2017–2019 of Cumulative Steroid Doses From ESI and Non-ESI procedures in Post-Menopausal Women. The women were represented as being either above the maximum recommended dose of <200 ​mg over a 1-year period (darker shading) or below the dose (lighter shading) Abbreviations: ESI, epidural steroid injections; MDPE, methylprednisolone dose equivalent.
Fig. 2
Fig. 2
Individual Cumulative 3-Year Steroid Doses for Cases Exceeding 400 ​mg MPDE in Post-Menopausal Women. The cumulative 3-year steroid dose in the 24 individual post-menopausal female cases in whom the recommended 400 ​mg MPDE 3-yearly dose was exceeded. Cumulative amounts for each case are broken down into the steroid delivery via ESI procedures (dark blue) or by additional non-ESI-based procedures (light blue), with the red-dotted line depicting the 400 ​mg MPDE threshold. Abbreviations: ESI, epidural steroid injectionss
Fig. 3
Fig. 3
Cumulative 3-year Steroid Amounts by Age. Scatter plot depicting total cumulative 3-year steroid dose administered in MPDE for all patients by age (inclusive of ESI ​+ ​additional non-ESI steroid-based procedures).
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