کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
2762591 1150719 2013 5 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
The effect of epidural methylprednisolone acetate injection on the hypothalamic-pituitary-adrenal axis
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی بیهوشی و پزشکی درد
پیش نمایش صفحه اول مقاله
The effect of epidural methylprednisolone acetate injection on the hypothalamic-pituitary-adrenal axis
چکیده انگلیسی

Study ObjectiveTo evaluate the effect of an epidural corticosteroid injection of 80 mg and 40 mg of methylprednisolone acetate on the hypothalamic-pituitary-adrenal axis and on back pain.DesignRandomized, single-blinded prospective study.SettingOperating room of a university-affiliated hospital.Patients42 patients with low back pain due to radiculopathy.InterventionsGroup 1 received an epidural corticosteroid injection of 80 mg of methylprednisolone acetate, and Group 2 received an epidural corticosteroid injection of 40 mg of methylprednisolone acetate. All study patients underwent a stimulation test of one μg of adrenocorticotropin hormone (ACTH), and their pain levels were graded just prior to and following the epidural corticosteroid injection on weeks one, 3, and 4.MeasurementsSerum cortisol of the ACTH stimulation tests and back pain levels were rated using a visual analog scale (VAS). Serum cortisol levels lower than 18 ng/mL 30 minutes following the ACTH stimulation test were considered to be secondary adrenal insufficiency.Main Results21 patients were enrolled in each group. The rate of secondary adrenal insufficiency in Group 1 was ~ 86%, ~ 22%, and ~ 17% of patients versus ~ 53% (P = 0.024), 15% (P = 0.874), and ~ 12% (P = 0.715) of Group 2 patients at weeks one, 3, and 4, respectively. About 62%, 56%, and 39% of Group 1 patients had a favorable clinical response as opposed to ~ 47% (P = 0362), 35% (P = 0.21), and ~ 6% (P = 0.049) of Group 2 patients at weeks one, 3, and 4, respectively.ConclusionsEpidural corticosteroid injection of methylprednisolone acetate in both groups was associated with very high rates of secondary adrenal insufficiency, but significantly more so in Group 1 at week one. This suppression was transient, with recovery of the gland in most patients noted over the ensuing weeks. An epidural corticosteroid injection of 80 mg had higher rates of favorable clinical response than a 40 mg injection, but significantly more so at week 4 only. This favorable response waned over a few weeks in both groups.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Journal of Clinical Anesthesia - Volume 25, Issue 8, December 2013, Pages 629–633
نویسندگان
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