Should I increase pred?

[Marilyn1959]

I am having a procedure tomorrow, a deep injection into replacement shoulder. I don't have name of procedure as I was notified by telephone so have no paperwork. I am anxious as I recently had adverse reaction to injection at dentist. The dentist felt that the adrenaline in the injection was the cause of my reaction.

I have told the pain management team of this reaction. They have decided that they will not use local anaesthetic, though have said that normally an adverse reaction during tomorrows procedure would be treated with a shot of adrenaline??????

As I have never had this reaction to injections previously I am wondering whether my adrenal glands are perhaps starting to kick in (or not)? I am currently on 6.5mgs. I am considering increasing my pred dose in the morning, ahead of the procedure tomorrow. Would this be a good idea? If so increase by how much?

[PMRpro Ambassador]

Is it a deep injection - or a "depot" injection? Why is it being done?

Personally I would think the daily pred dose is something you should discuss with the pain team - you can take more pred when you get there if they think it is appropriate. They may well use hydrocortisone during the procedure.

[SnazzyD]

Hello, the adverse reaction that would be needing adrenaline is (rare) anaphylaxis, a severe allergic reaction to the injection, as with any drug. In that case you would be glad of it as it would reverse the effects of the histamine storm.

I’ve had the same reaction to the dentist’s anaesthetic/adrenaline mix before Pred, as I said before and it has had no bearing on any other medication I’ve had since, even some hefty IV meds.

[DorsetLady PMRGCAuk volunteer]

To be honest, I don’t think we can answer that...especially as we don’t know exactly what it is. . one of the medically trained members might know.

Is it possible to speak to a member of the team this afternoon and explain you still have concerns.

My gut feeling would be not to increase, but take extra with you in case required.

Good luck at please let us know outcome. As a fellow shoulder replacement recipient am interested in why’s and wherefores.

[Marilyn1959 in reply to DorsetLady]

Update. For second time I arrived to have this injection, the first time was at hospital. This time was at a health hub. On both occasions injection aborted. First time was because the hospital could not prescribe prophylactic antibiotics I have to have and also the clinician said she didn't feel the room allocated was sterile enough. Today's venue was even less sterile, clinician said procedure was very high risk of infection and venue was not sterile enough. Meanwhile, in anticipation I had started course of antibiotics 24 hours ahead of procedure as advise!

For DL - The reason for the injection is to try to delay, (by having injection followed by further physio in the hope of enabling me greater movement of arm), a further operation (this time a reverse shoulder op). Apparently I am a bit younger than they would like for this op!

[DorsetLady PMRGCAuk volunteer in reply to Marilyn1959]

So why a second operation? Other than lack of movement. Was first not a full replacement?