# Cumulative glucocorticoid exposure in patients receiving epidural steroid injections: A single-centre retrospective evaluation on 581 procedures against existing clinical recommendations

## TL;DR

This study found that many patients receiving epidural steroid injections exceeded recommended steroid dose limits, especially when including non-epidural injections.

## Contribution

The study highlights the risk of exceeding safe steroid dose limits in post-menopausal women through cumulative exposure from multiple injection types.

## Key findings

- 4.7% of postmenopausal women exceeded the annual 200 mg steroid limit from epidural injections alone.
- Including non-epidural injections increased the exceedance rate to 15.3%.
- Mean steroid dose per injection was nearly double the recommended 40 mg.

## Abstract

The purpose of the study was to review the cumulative corticosteroid doses received from epidural and non-epidural-based pain interventions in a cohort of patients undergoing epidural steroid injections (ESIs) with comparison to safe dosing recommendations.

Retrospective analysis was undertaken for all 349 patients who underwent a total of 581 ESIs at a single-centre, tertiary hospital in South Australia between 2017 and 2019. The primary outcome was the yearly dose analysis of cumulative steroid doses in methylprednisolone equivalents (MDPE) administered from epidural and non-epidural interventions in post-menopausal women, interpreted against maximum recommended doses.

The annual limit of 200 ​mg for postmenopausal women was exceeded in 4.7% of the time (11/235) from ESIs alone, with a significant rise to 15.3% (46/300) when non-ESI injections were included in cumulative dose totals(p ​< ​0.001). Of the 173 participants of post-menopausal female age, 4.1% (7/173) received cumulative corticosteroid doses above the 3-year 400 ​mg MPDE limit from ESIs alone, with a statistically significant increase to 13.9% (24/173) when non-epidural steroid injections were again included in cumulative dose totals (p ​< ​0.001). The mean ​± ​standard deviation administered MPDE per epidural steroid injection across the whole study cohort was 72 ​± ​22 ​mg, nearly double the recommended dose of 40 ​mg.

Our study underpins the need for vigilance when considering steroid-based pain interventions, wherein both the individual and cumulative steroid exposure should be considered.

•Steroid exposure from epidural- and non-epidural interventions.•Steroid exposure in post-menopausal women.•Risk of excess steroid exposure is a possibility from epidural and non-epidural interventions.•Physicians should be vigilant about excess steroid exposure.

Steroid exposure from epidural- and non-epidural interventions.

Steroid exposure in post-menopausal women.

Risk of excess steroid exposure is a possibility from epidural and non-epidural interventions.

Physicians should be vigilant about excess steroid exposure.