PERINEAL PAIN AND DISCOMFORT: A STRANGE PHENOMENON FOLLOWING INTRAVENOUS DEXAMETHASONE

SINDHU CB; ABDUL ASLAM P; SANDHYA GEORGE

doi:10.22159/ajpcr.2024.v17i4.49670

Authors

SINDHU CB Department of Dermatology, Government Medical College, Manjeri, Kerala, India. https://orcid.org/0000-0002-1201-5563
ABDUL ASLAM P Department of Pharmacology, Government Medical College, Manjeri, Kerala, India
SANDHYA GEORGE Department of Dermatology, Government Medical College, Kozhikkode, Kerala, India https://orcid.org/0000-0002-5902-2509

DOI:

https://doi.org/10.22159/ajpcr.2024.v17i4.49670

Keywords:

Inpatients, IV (Intravenous),, Dexamethasone, Perineal irritation

Abstract

Objectives: The objectives of this study were to estimate the incidence of perineal discomfort, to assess the type of perineal discomfort, and to determine the time frame in which the discomfort started and persisted following IV administration of Dexamethasone in patients in the wards of a tertiary care teaching hospital.

Methods: This study was a descriptive cross-sectional study among 235 inpatients of a tertiary care hospital in Kerala receiving IV Dexamethasone. Study setting was in-patient wards of Government Medical College, Manjeri, Kerala. The study duration was 6 months from the date of IEC approval.

Results: Out of the 235 patients enrolled to the study, 126 (55.6%) were male and 109 (44.4%) were female. The mean age of the patients enrolled was 55.85±16.657. About 63 (26.8%) patients developed abnormal discomfort or symptoms following IV Dexamethasone injection. Patients presented the symptoms mainly over perineal area, perianal area, and lower abdomen. About 50 (79.4%) presented with symptoms in perineal area. All the 63 (100%) patients who experienced the symptoms had sudden and spontaneous onset of symptoms while administering the injection and the duration of the symptoms varied from few seconds to 5 min. There was no significant relationship between gender and dosage with appearance of symptoms.

Conclusion: In clinical practice, health-care professionals should be aware of such transient symptoms of perineal irritation and pruritus followed by IV Dexamethasone. Even though the exact mechanism is not known, this should be kept in mind and proper dilution and slow administration of the dexamethasone should be done to reduce such symptoms.

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References

Alangari AA. Corticosteroids in the treatment of acute asthma. Ann Thorac Med. 2014;9(4):187-92. doi: 10.4103/1817-1737.140120. PMID:25276236

Henzi I, Walder B, Tramèr MR. Dexamethasone for the prevention of postoperative nausea and vomiting: A quantitative systematic review. Anesth Analg. 2000;90:186-94.

Sheikh A. Glucocorticosteroids for the treatment and prevention of anaphylaxis. Curr Opin Allergy Clin Immunol. 2013;13(3):263-7. doi: 10.1097/ACI.0b013e32836097f4. PMID:23507835

Quon BS, Gan WQ, Sin DD. Contemporary management of acute exacerbations of COPD: A systematic review and metaanalysis. Chest. 2008;133(3):756-66. doi: 10.1378/chest.07-1207. PMID:18321904

Choo KJ, Simons E, Sheikh A. Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review. Allergy. 2010;65(10):1205-11. doi: 10.1111/j.1398-9995.2010.02424.x. PMID:20584003

World Health Organisation. World Health Organisation Model List of Essential Medicines, 21st List. Geneva: WHO; 2019.

Perron G, Dolbec P, Germain J, Béchard P. Perineal pruritus after i.v. Dexamethasone administration. Can J Anaesth. 2003;50:749-50.

Thomas V. More on dexamethasone-induced perineal irritation. N Engl J Med. 1986;314:1643-4.

Ajmal M, Carey M. Intravenous bolus injection of dexamethasone and transient excruciating perineal pain. Eur J Anaesthesiol. 2015;32(1):67-8.

Singh M, Sharma CS, Rautela RS, Taneja A. Intravenous dexamethasone causes perineal pain and pruritus. J Anesth Clin Res. 2011;S1:1-3.

Neff SP, Stapelberg F, Warmington A. Excruciating perineal pain after intravenous dexamethasone. Anaesth Intensive Care. 2002;30(3):370-71.

Crandell JT. Perineal pruritus after the administration of iv dexamethasone. Can J Anaesth. 2004;5:398; author reply 398-9.

Bindra S, Annavarjula V, Tyro D. Dexamethasone induced perineal pruritus in patients undergoing minor oral surgical procedures-a prospective cohort study. J Clin Diagn Res. 2022;16(1):ZC18-21.

Dowd N, Nizam A. Intravenous dexamethasone induced-perineal irritation. Br J Anaesth. 2008;100(eLetters Supplement):101. doi: 10.1093/bja/el_3504

Taleb N, Geahchan N, Ghosn M, Brihi E, Sacre P. Vulvar pruritus after high-dose dexamethasone. Eur J Cancer Clin Oncol. 1998;24:495.

Lokesh U, Jannu A, Bhattacharya D. Excruciating pain and itching occurring at the administration site after intravenous injection of dexamethasone-a prospective clinical study. IOSR J Pharm Biol Sci. 2014 May-Jun;9(3):13-4.