Steroid injections in pain management: influence on coronavirus disease 2019 vaccines

The coronavirus disease 2019 (COVID-19) pandemic, which has been rampant since the end of 2019, has evidently affected pain management in clinical practice.Fortunately, a COVID-19 vaccination program is currently in progress worldwide.There is an ongoing discussion that pain management using steroid injections can decrease COVID-19 vaccine efficacy, although currently there is no direct evidence to support this statement. As such, the feeling of pain in patients is doubled in addition to the co-existing ill-effects of social isolation associated with the pandemic.Thus, in the COVID-19 era, it has become necessary that physicians be able to provide high quality pain management without negatively impacting COVID-19 vaccine efficacy. Steroids can alter the entire process involved in the generation of adaptive immunity after vaccination. The period of hypophysis-pituitary-adrenal axis suppression is known to be 1 to 4 weeks after steroid injection, and although the exact timing for peak efficacy of COVID-19 vaccines is slightly different for each vaccine, the average is approximately 2 weeks. It is suggested to avoid steroid injections for a total of 4 weeks (1 week before and after the two vaccine doses) for the doubleshot vaccines, and for 2 weeks in total (1 week before and after vaccination) for a single-shot vaccine. This review focuses on the basic concepts of the various COVID-19 vaccines, the effect of steroid injections on vaccine efficacy, and suggestions regarding an appropriate interval between the administration of steroid injections and the COVID-19 vaccine.

The effect of endotracheal 1% lidocaine administration to reduce emergence phenomenon after general anesthesia

BACKGROUND: Endotracheal intubation often causes sore throat and coughing. The aim of this study was to decrease the incidence and severity of cough, sore throat, and hemodynamic changes after extubation by endotracheal administration of 1% lidocaine. METHODS: Sixty patients physical status American Society of Anesthesiologists classes I, II, and III who received a surgery under general anesthesia were randomly divided into two groups. L group was given 1% lidocaine 0.5 mg/kg by endotracheal administration. The other group, N group, received the same volume of normal saline. The number of cough, the severity of sore throat with numerical rating score (NRS), incidence of local anesthetic systemic toxic reaction, laryngospasm, and hoarseness were recorded. In addition, the number of coughs was divided into three levels by its severity, and it was converted into an indicator of cough score. RESULTS: L group had a significantly lower number of cough and sore throat NRS (P value < 0.05) than the N group, and also hoarseness did not occur. The changes in the hemodynamic parameters, before and after the emergence of anesthesia, were more stable in the L group than those in the N group, but not statistically significant. CONCLUSIONS: The results of this study suggest that endotracheal administration of 1% lidocaine is effective and safe method to reduce cough and sore throat caused by extubation.

A comparison between the right side and the left side of head skin in a patient who received more than 450 sessions of left stellate ganglion block: A case report

Stellate ganglion block (SGB) is an effective method that is used by pain clinicians to treat patients who have pain in the head, neck and arm area. SGB acts mainly by increasing regional blood flow via peripheral vasodilation and decreasing pain sensation by reducing the afferent sensory signals of the sympathetic nervous system in the region. This patient had received more than 450 sessions of left SGB continually for the past 6 years to relieve her left-sided facial pain caused by facial trauma. Out of our curiosity, we tried to obtain some objective dermatological measurements like skin elasticity, water content, and hair follicle density on her scalp and we found that the values were different between the left side of her face and the right side of her face. Here, we report the results and we want pain clinicians to know that repeated SGBs may improve skin elasticity, water content in the skin, and increase the number of hair follicles on the scalp.

A comparison between the right side and the left side of head skin in a patient who received more than 450 sessions of left stellate ganglion block: A case report

Stellate ganglion block (SGB) is an effective method that is used by pain clinicians to treat patients who have pain in the head, neck and arm area. SGB acts mainly by increasing regional blood flow via peripheral vasodilation and decreasing pain sensation by reducing the afferent sensory signals of the sympathetic nervous system in the region. This patient had received more than 450 sessions of left SGB continually for the past 6 years to relieve her left-sided facial pain caused by facial trauma. Out of our curiosity, we tried to obtain some objective dermatological measurements like skin elasticity, water content, and hair follicle density on her scalp and we found that the values were different between the left side of her face and the right side of her face. Here, we report the results and we want pain clinicians to know that repeated SGBs may improve skin elasticity, water content in the skin, and increase the number of hair follicles on the scalp.