Perioperative Steroid Management

Liu, Melanie M.; Reidy, Andrea B.; Saatee, Siavosh; Collard, Charles D.

doi:10.1097/aln.0000000000001659

Cited by 107 publications

(47 citation statements)

References 18 publications

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“…Pain treatments can also compromise the immune system in particular with the use of steroids. Oral or injected steroids can induce secondary adrenal insufficiency altering immune response [ 26 ]. Opioids, in general, decrease natural killer (NK) cells in a dose-dependent manner, and therefore, they are associated with the progression of infectious states.…”

Section: Chronic Pain Features and Therapeutic Challenges During Covimentioning

confidence: 99%

Impact of COVID-19 pandemic on chronic pain management: Looking for the best way to deliver care

Puntillo

Giglio²,

Brienza

et al. 2020

Best Practice & Research Clinical Anaesthesiology

113

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Although pain treatment has been described as a fundamental human right, the Coronavirus disease 2019 (COVID-19) pandemic forced healthcare systems worldwide to redistribute healthcare resources toward intensive care units and other COVID-19 dedicated sites. As most chronic pain services were subsequently deemed non-urgent, all outpatient and elective interventional procedures have been reduced or interrupted during the COVID-19 pandemic in order to reduce the risk of viral spread. The shutdown of pain services jointly to the home lockdown imposed by governments has affected chronic pain management worldwide with additional impact on patients' psychological health. Therefore, the aim of this review is to analyze the impact of COVID-19 pandemic on chronic pain treatment and to address what types of strategies can be implemented or supported in order to overcome imposed limitations in delivery of chronic pain patient care.

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Section: Chronic Pain Features and Therapeutic Challenges During Covimentioning

confidence: 99%

Impact of COVID-19 pandemic on chronic pain management: Looking for the best way to deliver care

Puntillo

Giglio²,

Brienza

et al. 2020

Best Practice & Research Clinical Anaesthesiology

113

View full text Add to dashboard Cite

show abstract

“…These figures are concerning given that opioids may theoretically mask or delay the detection of symptoms of COVID-19, such as myalgia, cough and shortness of breath. 30 In addition, the immunosuppressant effects of chronic opioid treatment may potentially increase COVID-19 risk. 13 , 31 As prolonged analgesia use has been associated with elevated mortality risk in osteoarthritis patients, 32 the cardiac and COVID-19 risks of SCS patients need to be carefully considered and quantified.…”

Section: Discussionmentioning

confidence: 99%

The impact of the COVID-19 pandemic on patients awaiting spinal cord stimulation surgery in the United Kingdom: a multi-centre patient survey

Baranidharan

Bretherton

Eldabe

et al. 2020

British Journal of Pain

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Introduction: Spinal cord stimulation (SCS) is a recommended treatment for chronic refractory neuropathic pain. During the COVID-19 pandemic, elective procedures have been postponed indefinitely both to provide capacity to deal with the emergency caseload and to avoid exposure of elective patients to COVID-19. This survey aimed to explore the effect of the pandemic on chronic pain in this group and the views of patients towards undergoing SCS treatment when routine services should resume. Methods: This was a prospective, multi-centre telephone patient survey that analysed data from 330 patients with chronic pain who were on an SCS waiting list. Questions focussed on severity of pain, effect on mental health, medication consumption and reliance on support networks during the COVID-19 pandemic. Views towards undergoing SCS therapy were also ascertained. Counts and percentages were generated, and chi-square tests of independence explored the impact of COVID-19 risk (very high, high, low) on survey responses. Results: Pain, mental health and patient’s ability to self-manage pain deteriorated in around 47%, 50% and 38% of patients, respectively. Some patients reported increases in pain medication consumption (37%) and reliance on support network (41%). Patients showed a willingness to attend for COVID-19 testing (92%), self-isolate prior to SCS (94%) and undergo the procedure as soon as possible (76%). Conclusion: Our findings suggest that even during the COVID-19 pandemic, there remains a strong clinical need for patients with chronic pain identified as likely SCS responders to be treated quickly. The current prioritisation of new SCS at category 4 (delayed more than 3 months) is challenged judging by this national survey. These patients are awaiting SCS surgery to relieve severe intractable neuropathic pain. A priority at category 3 (delayed up to 3 months) or in some selected cases, at category 2 are the appropriate priority categories.

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“…In this study, 92% of patients with resected sellar lesions had adrenal insufficiency at the time of THA. For these patients, additional corticosteroid supplementation was required in the perioperative period to reduce the risk of adrenal crisis [29]. This usually delayed discharge after THA, because a subsequent tapering process was required to return the steroid to its ordinary dose.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head Following Surgical Treatment of Brain Tumors

Lim

Park

Kim

et al. 2019

JCM

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Corticosteroids have been widely used in patients with brain tumors to reduce tumor-associated edema and neurological deficits. This study examined the outcomes of total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH) following brain tumor surgery. We identified 34 THAs performed in 26 patients with steroid-induced ONFH among 9254 patients undergoing surgical treatment for primary brain tumors. After propensity score matching with demographics, 68 THAs (52 patients) in ONFH unrelated to brain tumors were selected as the control group. At the time of THA, 54% of brain tumor patients had neurological sequelae and 46% had adrenal insufficiency. After THA, patients with brain tumor required longer hospital stay, reported a lower functional score, and showed a higher rate of heterotopic ossification compared to the control group. However, hip pain score improved significantly after THA in the brain tumor group, and did not differ from that of the control group (P-value = 0.168). Major complication rates were similar (2.9% and 1.5% for the brain tumor and control groups, respectively; P-value = 1.000), and implant survivorships were not different at 7 years (100% and 98.1% for the brain tumor and control groups, respectively; P-value = 0.455). Our findings suggest that THA can be safely performed to reduce hip pain in patients with steroid-induced ONFH after surgical treatment of primary brain tumors.

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Perioperative Steroid Management

Abstract: Perioperative stress-dose steroid administration remains a controversial topic, with recent studies questioning its necessity. We discuss the current literature, largely published in nonanesthesiology journals, and suggest a practical approach to perioperative steroid management.

Cited by 107 publications

References 18 publications

Impact of COVID-19 pandemic on chronic pain management: Looking for the best way to deliver care

Impact of COVID-19 pandemic on chronic pain management: Looking for the best way to deliver care

The impact of the COVID-19 pandemic on patients awaiting spinal cord stimulation surgery in the United Kingdom: a multi-centre patient survey

Outcomes of Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head Following Surgical Treatment of Brain Tumors

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