FYI, in case you need to train your doctor.
Steroids Provide Temporary Improvement of Refractory Pain Following Subarachnoid Hemorrhage
Abstract
Introduction
Evidence
for optimal analgesia following subarachnoid hemorrhage (SAH) is
limited. Steroid therapy for pain refractory to standard regimens is
common despite lack of evidence for its efficacy. We sought to determine
if steroids reduced pain or utilization of other analgesics when given
for refractory headache following SAH.
Methods
We
performed a retrospective within-subjects cohort study of SAH patients
who received steroids for refractory headache. We compared daily pain
scores, total daily opioid, and acetaminophen doses before, during, and
after steroids. Repeated measures were analyzed with a multivariable
general linear model and generalized estimating equations.
Results
Included
52 patients treated with dexamethasone following SAH, of whom 11
received a second course, increasing total to 63 treatment epochs. Mean
pain score on the first day of therapy was 7.92 (standard error of the
mean [SEM] .37) and decreased to 6.68 (SEM .36) on the second day before
quickly returning to baseline levels, 7.36 (SEM .33), following
completion of treatment. Total daily analgesics mirrored this trend.
Mean total opioid and acetaminophen doses on days one and two and two
days after treatment were 47.83mg (SEM 6.22) and 1848mg (SEM 170.66),
34.24mg (SEM 5.12) and 1809mg (SEM 150.28), and 46.38mg (SEM 11.64) and
1833mg (SEM 174.23), respectively. Response to therapy was associated
with older age, decreasing acetaminophen dosing, and longer duration of
steroids. Hyperglycemia and sleep disturbance/delirium effected 28.6%
and 55.6% of cases, respectively.
Conclusion
Steroid therapy for refractory pain in SAH patients may have modest, transient effects in select patients.
No comments:
Post a Comment