Effect of repeated transforaminal epidural low-dose dexamethasone injections on glucose profiles of diabetic and non-diabetic patients with low back pain

• Published in: Journal of anesthesia 2023-04, Vol.37 (2), p.261-267
• Main Authors: Hoshino, Reiko, Wakaizumi, Kenta, Otsuka, Yasuhisa, Morisaki, Hiroshi, Kosugi, Shizuko
• Format: Article
• Language: English
• Subjects: ACTH; Adrenocorticotropic Hormone; Anesthesiology; Backache; Blood sugar; Care and treatment; Critical Care Medicine; Dexamethasone; Diabetes Mellitus - drug therapy; Diabetics; Dosage and administration; Emergency Medicine; Glucose; Glycated Hemoglobin; Glycosylated hemoglobin; Humans; Hydrocortisone; Intensive; Intermedin; Low Back Pain - drug therapy; Medical colleges; Medicine; Medicine & Public Health; Original Article; Pain Medicine
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-022-03160-6

Purpose We aimed to investigate the effect of repeated transforaminal epidural low-dose dexamethasone injections on glucose profiles and pituitary-adrenal axis functions of diabetic and non-diabetic patients with low back pain. Methods A total of 28 patients (ten diabetic [DM group] and 18 non-diabetic patients [non-DM group]) with low back pain were followed-up. Transforaminal epidural low-dose dexamethasone (1.65 mg) injections were repeated every 7–14 days for 8 weeks. Fasting blood sugar (FBS), hemoglobin A1c (HbA1c), morning plasma adrenocorticotropin (ACTH), and cortisol levels were measured at baseline and during the 8-week follow-up period. Results There were no significant changes in FBS and HbA1c levels between baseline and 8-week follow-up period in both DM and non-DM groups (difference in FBS [95% confidence Interval, CI]: − 0.6 mg/dL [− 6.4, 5.1], p  = 0.83 in the non-DM group, − 0.2 mg/dL [− 26.2, 25.8], p  = 0.99 in the DM group; difference in HbA1c [95% CI] − 0.02% [− 0.1, 0.1], p  = 0.69 in the non-DM group, 0.04% [− 0.3, 0.4], p  = 0.79 in the DM group). There were no significant longitudinal changes in ACTH and cortisol levels (ACTH, p  = 0.38 [baseline vs. 8 week], p  = 0.58 [non-DM vs. DM]; cortisol, p  = 0.52 [baseline vs. 8 week], p  = 0.90 [non-DM vs. DM]). Conclusions Repeated transforaminal epidural low-dose dexamethasone injections provided no significant elevations in blood glucose or suppression of the pituitary-adrenal axis for two months from the first injection in both diabetic and non-diabetic patients. Our results indicate the intermediate-term safety of repeated transforaminal epidural low-dose dexamethasone injections with regard to the effect on glucose profile and pituitary-adrenal axis functions.