Dihydroergotamine and mobilization after major orthopedic surgery

Abstract

The effects of dihydroergotamine (DHE) on the degree of mobilization and response to orthostatic stress after total hip arthroplasty were studied. In the mobilization study, 78 patients received DHE, 0.5 mg im, twice a day from the day of surgery until full mobilization was achieved. Eighty-four patients who received placebo served as controls. There was no significant difference in the time until the first day of mobilization or the degree of mobilization. In the orthostatic test condition, subgroups of 61 patients receiving placebo and 55 patients receiving DHE were subjected to orthostatic testing. There were no differences in cardiovascular response to bed rest or in orthostatic stress. We conclude that DHE does not stabilize the cardiovascular reaction to orthostatic stress, nor does it enhance mobilization in patients after total hip arthroplasty.

Orthostatic Intolerance-Type Events Following Hip and Knee Arthroplasty

“…In 4 studies 7,17,20,23 , orthostatic hypotension was defined as a drop in systolic and/or diastolic blood pressure following a change in body position (e.g., a drop of ≥20 mm Hg in systolic blood pressure and/or a drop of ≥10 mm Hg in diastolic blood pressure during standing compared with the supine position, as reported by Cheng et al 17 ). Arterial blood pressure was measured using a mercury manometer by the auscultatory method in 1 study 19 . Three studies used a beat-to-beat measurement of arterial blood pressure recorded noninvasively by photoplethysmography using finger cuffs 7,20,23 .…”

“…Two studies did not report the follow-up time point for the incidence of an orthostatic hypotension event 19,21 . Duus et al 19 reported an incidence proportion of 16% (95% CI, 9% to 28%), and Kaplan et al 21 reported an incidence proportion of 23% (95% CI, 17% to 31%). The overall pooled incidence proportion of an orthostatic hypotension event for the unilateral THA population was 26% (95% CI, 19% to 33%).…”

“…The estimated pooled incidence proportion was 15% (95% CI, 10% to 19%). Two studies did not report the follow-up time point for the incidence of an orthostatic hypotension event 19,21 . Duus et al 19 reported an incidence proportion of 16% (95% CI, 9% to 28%), and Kaplan et al 21 reported an incidence proportion of 23% (95% CI, 17% to 31%).…”

“…Of the 292 identified published reports, 38 were considered eligible for full-text manuscript review. Twenty-one reports (14,055 patients) met the inclusion criteria and were included in this review 7,8,13-31 (Fig. 1).…”

“…auscultatory method in 1 study 19 . Three studies used a beat-tobeat measurement of arterial blood pressure recorded noninvasively by photoplethysmography using finger cuffs 7,20,23 .…”