Effects of dexamethasone on local infiltration analgesia in total knee arthroplasty: a randomized controlled trial

Ikeuchi, Masahiko; Kamimoto, Yuko; Izumi, Masashi; Fukunaga, K.; Aso, Koji; Sugimura, Natsuki; Yokoyama, Masataka; Tani, Tohru

doi:10.1007/s00167-013-2367-5

Cited by 106 publications

(169 citation statements)

References 26 publications

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“…No gray reference was included. Finally, 4 RCTs [10–13] which had been published between 2008 and 2016 were enrolled in present meta-analysis and include 183 participates in the dexamethasone groups and 178 patients in the control groups.…”

Section: Resultsmentioning

confidence: 99%

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The efficiency and safety of dexamethasone for pain control in total joint arthroplasty

Ji¹,

2017

Medicine

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Background:This meta-analysis aimed to evaluate the efficiency and safety of dexamethasone administration in total knee and hip arthroplasties.Methods:Two researchers search the relevant studies independently including Embase (1980–017.04), PubMed (1966–017.04), ScienceDirect (1985–017.04), Web of Science (1950–2017.03), and Cochrane Library for potential relevant studies. After testing for heterogeneity between studies, data were aggregated for random-effects models when necessary. The results of dichotomous outcomes were expressed as risk difference (RD) with a 95% confidence intervals (CIs). For continuous various outcomes, mean difference (MD) or standard mean difference (SMD) with a 95% confidence intervals (CIs) was applied for assessment. Meta-analysis was performed using Stata 11.0 software.Results:Four randomized controlled trials (RCTs) including 361 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of visual analogue scale (VAS) score at 12 hours (SMD = −0.579, 95% CI: −0.780 to −0.357, P = .000), 24 hours (SMD = −0.820, 95% CI: −1.036 to −0.604, P = .000), and 48 hours (SMD = −0.661, 95% CI: −1.149 to −0.172, P = .008). Dexamethasone was associated with a lower opioid consumption at 12 hours (SMD = −0.245, 95% CI: −0.465 to −0.025, P = .029), 24 hours (SMD = −0.285, 95% CI: −0.505 to −0.064, P = .011), and 48 hours (SMD = −0.989, 95% CI: −1.710 to −0.267, P = .007).Conclusion:Dexamethasone could significantly reduce postoperative pain scores and opioid consumption within the 1st 48 hours following total joint arthroplasty (TJA). The overall evidence quality was moderate to low, further high-quality RCTs are needed to identify the optimal dose of dexamethasone for reducing pain after TJA.

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Section: Resultsmentioning

confidence: 99%

“…There is a variation in dosage of dexamethasone in experimental groups. Three studies [10,11,13] performed general anesthesia and one [12] performed spinal anesthesia. Patient control analgesia with opioid was applied in all participates for concomitant pain management.…”

Section: Resultsmentioning

confidence: 99%

The efficiency and safety of dexamethasone for pain control in total joint arthroplasty

Ji¹,

2017

Medicine

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“…An ideal therapy would retain the benefits of dex on engineered cartilage without the requirement for its exogenous supplementation, obviating the systemic 58 and joint level complications associated with clinical injections of steroids. 59,60 As such, the current study tested the hypothesis that the incorporation of PLGA microspheres (MS), with the ability to release dex from within chondrocyte-seeded agarose hydrogel constructs, would promote development of constructs with native mechanical properties and protect constructs from the deleterious effects of IL-1a, laying the foundation for future, clinically focused studies.…”

Section: Introductionmentioning

confidence: 99%

Dexamethasone Release from Within Engineered Cartilage as a Chondroprotective Strategy Against Interleukin-1α

RoachBrendan

Kelmendi-DokoArta

BalutisElaine

et al. 2016

Tissue Engineering Part A

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“…The enhanced and prolonged pain relief with the use of steroids in infiltration was in line with the results of other studies. [37][38][39][40][41] The significant reduction in postoperative pain seen with cocktail injection translates into reduction in hospital stay, facilitation of early rehabilitation, as well as increased patients' satisfaction. We found the cocktail to be effective and safe in postoperative pain control and early rehabilitation in TKA.…”

Section: Discussionmentioning

confidence: 99%

Multimodal Cocktail Injection relieves Postoperative Pain and improves Early Rehabilitation following Total Knee Replacement: A Prospective, Blinded and Randomized Study

Shah

Upadhyay

Shah

et al. 2017

Journal on Recent Advances in Pain

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Objectives: An effective postoperative analgesia following total knee arthroplasty (TKA) would shorten the rehabilitation period and improve patient satisfaction. The primary objective of the present study is to test the hypothesis that intraoperative multimodal cocktail injection can significantly reduce the consumption of analgesics and duration of time required to perform straight-leg raise, and improve range of motion (ROM) and patient satisfaction rate following TKA. Materials and methods:A total of 126 osteoarthritic knees in patients with a mean age of 68 years (58-80 years) scheduled for primary TKA were prospectively randomized into three groups. Patients in all three groups received the same anesthesia and postprocedure pain control and rehabilitation protocol. The assessor was blind with regard to multimodal cocktail injection for the duration of study. Assessment was done preoperatively at 1, 2, 3, and 4 postoperative days, and at 1, 2, and 3 months postoperatively. The primary outcome was function measured with Western Ontario and McMaster Universities Arthritis Index. Pain and patient satisfaction rate were established using visual analog scale and Likert scale respectively. Consumption of analgesic during the postoperative days (1-4 days), hospital stay, and ROM were recorded and evaluated. Outcome measures were critically analyzed. The level of significance was set at <0.05. Results:Pain, functional scores, and satisfaction rates were significantly better in cocktail group than in the control group (p < 0.05). Consumption of nonsteroidal anti-inflammatory drugs was significantly lower in groups with multimodal cocktail injection than in the control group (p < 0.05). Mean follow-up time was 3 months with no patient lost to follow-up. No complications related to the infiltration of the local anesthetic and/or steroids were observed. Conclusion:Multimodal cocktail injection offered improved postoperative pain control, thus facilitating early rehabilitation.

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Effects of dexamethasone on local infiltration analgesia in total knee arthroplasty: a randomized controlled trial

Abstract: Adding steroid to local anaesthetics in local infiltration analgesia reduced inflammation both locally and systemically, resulting in significant early pain relief and rapid recovery in total knee arthroplasty.

Cited by 106 publications

References 26 publications

The efficiency and safety of dexamethasone for pain control in total joint arthroplasty

The efficiency and safety of dexamethasone for pain control in total joint arthroplasty

Dexamethasone Release from Within Engineered Cartilage as a Chondroprotective Strategy Against Interleukin-1α

Multimodal Cocktail Injection relieves Postoperative Pain and improves Early Rehabilitation following Total Knee Replacement: A Prospective, Blinded and Randomized Study

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