Preliminary experience on systemic effects of perineural dexamethasone sodium phosphate and methylprednisolone acetate through adductor canal block in total knee arthroplasty: A single center retrospective study

Jinlei Li; Feng Dai; Bin Zhou; Milaurise Cortes; Khushboo Baldev

doi:10.4103/joacp.joacp_433_21

Preliminary experience on systemic effects of perineural dexamethasone sodium phosphate and methylprednisolone acetate through adductor canal block in total knee arthroplasty: A single center retrospective study

J Anaesthesiol Clin Pharmacol. 2023 Jul-Sep;39(3):385-391. doi: 10.4103/joacp.joacp_433_21. Epub 2023 Feb 2.

Authors

Jinlei Li¹, Feng Dai², Bin Zhou², Milaurise Cortes¹, Khushboo Baldev¹

Affiliations

¹ Department of Anesthesiology, School of Medicine, Yale University, 333 Cedar Street, New Haven, CT - 06520, United States.
² Department of Biostatistics, School of Public Health, Yale Center for Analytical Sciences, Yale University, 300 George Street, Suite 511, New Haven, CT 06511, United States.

Abstract

Background and aims: Glucocorticoids are commonly utilised as adjuvants to enhance nerve block quality and prolong the analgesic duration. Its systemic effects, after a single-injection adductor canal block (ACB) followed by a continuous infusion, are unclear. The aim of the study was to assess the systemic effects of a single dose of dexamethasone sodium phosphate (DEX), or a combination of DEX and methylprednisolone acetate (MPA), on fasting blood glucose (FBG) and white blood cell count (WBC) when administered perineurally via ACB.

Material and methods: A single-center retrospective study on total knee arthroplasty (TKA) was performed and a total of 95 patients were included in the final analysis. Patients were divided into three groups based on adjuvants received in ACB: Control group (N = 41) and two treatment groups, DEX group (N = 33) and DEX/MPA group (N = 21). Our primary outcomes were the change of FBG from its preoperative baseline value on postoperative day (POD) 2. The secondary outcomes included change of FBG on POD 0 and POD 1, and change of WBC on POD 0, POD 1, and POD 2.

Results: The FBG change from baseline in the DEX group was significantly higher than that in the control group (difference = 14.04, 95% CI: 1.3 to 26.77), P = 0.031) on POD 0. The WBC change from baseline in the DEX/MPA group was statistically significant higher than control on POD 0 (2.62 (1.52 to 3.37), P < 0.0001). No significant differences between DEX and DEX/MPA group were found on any given postoperative days for FBG and WBC.

Conclusion: This study provided preliminary safety data on the use of a combination of glucocorticoids with hydrophilic (DEX) and lipophilic (MPA) properties as local anesthetic adjuvants in ACB, which induced similar levels of changes on FBG and WBC as those from both control and DEX alone group.

Keywords: Continuous adductor canal block; Depo-Medrol; dexamethasone; methylprednisolone acetate; perineural glucocorticoid; total knee arthroplasty.