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

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:

• perineural glucocorticoid
• perineural dexamethasone
• perineural methylprednisolone acetate
• total Hip arthroplasty
• fascia plane block
• serum glucose

Acknowledgments

1. The authors would like to thank the entire team of total joint arthroplasty surgeons at Yale University, especially Drs. Lee Rubin, Michael Leslie, Mary O’Connor, Daniel Wiznia, Diren Arsoy, David Gibson, Michael Baumgartner, Joseph Wu, Michael Luchini, and Philip Luchini, who contributed their patients for the study.

2. The authors would like to thank Mr. Richard Hintz and Mrs. Soundari Sureshanand at JDAT-Research, YCCI at Yale University School of Medicine for electronic medical record data acquisition.

Disclosure

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.

Additional information

Funding

This publication was made possible by CTSA Grant Number UL1 TR000142 from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.