To the Editor W e read the article, "Postoperative Analgesic Efficacy and Safety of Ropivacaine Plus Diprospan for Pre-emptive Scalp Infiltration in Patients Undergoing Craniotomy: A Prospective Randomized Controlled Trial," by Han et al 1 published in your esteemed journal with great interest. We commend the authors who evaluated the analgesic efficacy of the combination of ropivacaine and diprospan and concluded that it can effectively attenuate postoperative pain without any serious adverse events and improve recovery for patients undergoing craniotomy. However, we have a few comments to improve the interpretation of their findings.The authors added 0.5 mL of diprospan (1 mL diprospan contains 5 mg of betamethasone propionate and 2 mg of betamethasone sodium phosphate) to ropivacaine to increase the analgesic efficacy. Corticosteroids increase the analgesic efficacy through their anti-inflammatory action and afferent nociceptive signaling. 2 The authors state that no patient experienced any side effects associated with the incisional infiltration of diprospan, which include postoperative delayed wound healing, infection, peptic ulcer, or hemorrhage. However, one of the common metabolic side effects of systemic steroids is an increase in glucose values even in patients who are not at risk of diabetes mellitus. 3 The authors did not monitor their participants' blood glucose levels, which could have been more informative.Habib et al's study 4 evaluated the effect of intraarticular diprospan on blood glucose levels in diabetic patients and concluded that patients belonging to diprospan group had significantly higher levels of blood glucose following intra-articular injection. In another study involving diprospan, Wang et al 5 aimed to observe the analgesic effects of a cocktail formula containing ropivacaine, morphine, and diprospan for local infiltration analgesia in total hip arthroplasty. Blood sugar levels were monitored as a part of their secondary outcomes; it was concluded that there was no significant fluctuation of glucose levels (P = 1.000).However, 1 mL of diprospan was used in the aforementioned studies in contrast to 0.5 mL of diprospan by Han et al. 1 This low dose could have led to a lower elevation of blood glucose levels, but no conclusions could be drawn because there are no data available on it. Moreover, diabetes was a part of the exclusion criteria in this study. Monitoring of blood sugar levels in the perioperative period similar to the other studies and inclusion of diabetic individuals could have clarified the glycaemic effect of diprospan and thereby could have been useful for evaluating the safety profile of diprospan in diabetic patients.
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