Effects Of Continuous Epidural Injection Of Dexamethasone On Blood Glucose,Blood Lipid,Plasma Cortisol And ACTH In Patients Of Neuralgia

Objective:To study the effects of continuous epidural injection of different doses dexamethasone sodium phosphate on blood glucose,blood lipids,plasma cortisol and ACTH in patients of neuralgia.Methods:1.Thirty patients,with cervical spondylotic radiculopathy,lumbar disc herniation,herpes pain or postherpetic neuralgia were randomly divided into three groups:group S,group M and group L,whose function of heart,lung,liver,kidney and blood coagulation is normal.All of them had neither history of application of glucocorticoids in the past 2 months,nor epidural puncture contraindications or allergy to our drugs.2.The procedure was guided by CT,then the epidural catheter was connected to the analgesic pump.The analgesics were mixture of dexamethasone,bupivacaine,fentanyl and saline.The mixture analgesics had been injected continuously into the catheter by 10 days in all of the patients.The concentrations of bupivacaine,fentanyl were respectively 0.075%and2?g/ml,the injection speed was 2 ml/h.According to the dose of dexamethasone,the patients were divided into three groups randomly:group S:concentration of dexamethasone is 25?g/m;group M:concentration of dexamethasone is50?g/ml;group L:concentration of dexamethasone is 100?g/ml.3.Observation indicators:VAS,FBG,TC,TG,2hPG and the concentrations of cortisol,ACTH were recorded before injection?T₀?;2,4,6,8,and 10 days during the injection(D₂,D₄,D₆,D₈,D₁₀);7,14,21,28 Days?W₁,W₂,W₃,W4?after stopping injection.The occurrence of adverse effects such as pruritus,nausea,vomiting,urinary retention and catheter infection were recorded.Results:1.The VAS of each group was lower than that of T₀ after the catheterization and after the injection was stopped.The difference was statistically significant?P<0.05?.At the time of D₂ and W₄,the VAS of group S was higher than that of group M and group L,and the difference was statistically significant?P<0.05?.2.There was no significant difference in FBG between groups at T0?P>0.05?.The FBG after catheterization at each time point in L group was higher than that in S group and M group?P<0.05?.There was no significant difference in FBG between the S group and the M group?P>0.05?.There was no significant difference in FBG between the three groups after stopping injection?P>0.05?.All groups had higher levels of 2hPG after catheterization than T₀,but there was no significant difference?P>0.05?.3.There was no significant difference in TC and TG between the three groups at each time point?P>0.05?.At different time points,there was no significant difference in TC and TG between groups?P>0.05?.4.The concentrations of cortisol and ACTH in the three groups after catheterization were significantly lower than those in T₀?P<0.01?,there was no significant difference between the three groups after stopping injection?P>0.05?.Conclusions:1.Continuous epidural injection of dexamethasone at the concentration of100?g/ml can increase FBG,three different doses of dexamethasone can increase 2h PG,1 week after stopping the injection,both FBG and 2hPG returned to pre-injection levels.2.Continuous epidural injection of different doses of dexamethasone had no significant effect on blood lipids.3.Continuous epidural injection of dexamethasone for 1 day can reduce the concentration of cortisol and ACTH,and there was no significant difference between different doses.It could be restored to pre-injection level after stopping injection for 1 week.4.This study showed that the analgesic effect of continuous epidural injection of dexamethasone 50?g/ml group and 100?g/ml group had no significant difference,which was better than dexamethasone 25?g/ml,but the effect of blood glucose in dexamethasone 100?g/ml is greater than dexamethasone 50?g/ml.Therefore,the concentration of dexamethasone 50?g/ml is recommended for continuous epidural injection in the three different doses.