THU0497 THE EFFECT OF ADDITION OF BUFFERED DEXTROSE SOLUTION ON PAIN OCCURRING DURING LOCAL STEROID INJECTION FOR PLANTAR FASCIITIS
Authors: Abd alhafez Moshrif, Mohamed Elwan
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> 5%dextrose water (D5W) has been previously reported to decrease pain when co-administered with noxious agents as chemotherapeutics and microspheres<sup>(1,2)</sup>. It has also been reported to have an immediate analgesic effect on low back pain and radiculopathy when injected epidurally<sup>3</sup>. <h3>Objectives</h3> To evaluate the potential immediate analgesic effect of D5W when added to the injectate during local steroid injection for treatment of plantar fasciitis. <h3>Methods</h3> In this single blind study, a total of 122 patients with plantar fasciitis were randomly assigned to receive either 40 mg triamcinolone acetonide/1ml + 0.5ml. lidocaine 2% (group A: 61 patients; 73 heels) or 40mg triamcinolone acetonide/1ml+0.5ml. lidocaine2%+ 0.5ml. buffered D5W (group B: 61 patients; 69 heels) as a local injection using the medial approach. Clinical assessment including disease duration, BMI, history of previous injection and post-injection complications and 2week recurrence rate was performed. Plain X-ray lateral view on the painful heel was obtained for diagnosis of associating calcaneal spur. Visual analogue scale (VAS 0-10) was used to assess the degree of pain intensity during injection. <h3>Results</h3> There were no significant difference between both groups regarding age, sex or BMI where the mean for age was 42.56 years in group A and 43.39 years in group B (P = 0.86), the male to female ratio was 16:45 in both groups and the mean for BMI was 31.49 in group A and 30.86 in group B (P=0.51). The mean disease duration was 6.02 months in group A and 10.77 months in group B (P=0.005). Calcaneal spur was diagnosed in 60 patients (82%) in group A and in 47 patients (68%) in group B. <b>A highly significant difference in VAS was observed as the mean was 8.26±2.00 in group A and 4.25±2.05 in group B (P &lt;0.0001)</b> with a confidence interval (95% CI)of 7.78 -8.74 for group A and 3.76 - 4.72 for group B. On 2 week follow up, only 4 patients in each group reported a recurrent heel pain. No injection related side effects or complications have been reported. <h3>Conclusion</h3> The addition of 0.5 ml. D5W can significantly decrease the pain associated with local steroid injection for treatment of plantar fasciitis. Key words: plantar fasciitis, local injection, D5W, Pain <h3>References</h3> [1] T. Nakashima, Y. Ogawa, A. Kimura et al., "Coadministration of 5% glucose solution has a decrease in bendamustine-related vascular pain grade," Journal of Oncolog y Phar mac y Prac tice, vol. 18, no. 4, pp. 445–447, 2012. [2] K. J. Paprottka, S. Lehner, W. P. Fendler et al., "Reduced periprocedural analgesia aftr replacement of water for injection with glucose 5% solution as the infusion medium for 90Y-Resin microspheres," Jour nal of Nuclear Medic ine, vol. 57, no. 11, pp. 1679–1684, 2016. [3] Maniquis-Smigel L., Reeves K. D., Rosen H. J. et al., "Short term analgesic effects of 5% dextrose epidural injections for chronic low back pain: a randomized controlled trial," Anesthesiology and Pain Medicine, vol. 7, no. 1, Article ID e42550, 2017. <h3>Disclosure of Interests</h3> None declared