Methylprednisolone reduces postoperative nausea in total knee and hip arthroplasty

Miyagawa, Yasuhiro; Ejiri, Masayuki; Kuzuya, Takafumi; Osada, Takashi; Ishiguro, Naoki; Yamada, Kiyofumi

doi:10.1111/j.1365-2710.2009.01141.x

Cited by 31 publications

(22 citation statements)

References 16 publications

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“…Our findings agree with those of previous small series [15,36,38,40] and reviews of numerous perioperative settings [19,21,22,46] that found no association between corticosteroid use and increased risk for postoperative wound infection. Furthermore, studies using higher corticosteroid doses than that used in our study showed no increase in postoperative wound infection after major orthopaedic surgeries [1,5,19,25,46].…”

Section: Discussionsupporting

confidence: 93%

“…Previous studies have found that perioperative use of single, lowdose corticosteroids significantly decreased inflammatory markers after TKA [23,24,49]. However, despite the potential benefits and reported efficacy in numerous surgical procedures, only a few small studies involving less than 25 patients per group evaluated the efficacy and safety of corticosteroids after TKA [15,24,38,40]. Moreover, heterogeneity among studies regarding type, dosage, and administration protocol of corticosteroids and concomitant pain control regime make it difficult to judge the practical value of corticosteroid use after TKA.…”

Section: Introductionmentioning

confidence: 99%

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Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

Koh

Chang

Lee

et al. 2013

Clinical Orthopaedics &Amp; Related Research

118

147

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Background Dexamethasone is a potent analgesic and antiemetic. However, the benefit of dexamethasone after TKA is unclear, as is the efficacy in a current multimodal regime. Questions/purposes We determined (1) whether the addition of dexamethasone to a protocol including ramosetron further reduces postoperative emesis compared with ramosetron alone; (2) whether it reduces postoperative pain; and (3) whether it increases the risk for wound complications in a current multimodal regime after TKA. Methods We randomized 269 patients undergoing TKAs to receive dexamethasone (10 mg) 1 hour before surgery and ramosetron immediately after surgery (Dexa-Ra group, n = 135), or ramosetron alone (Ra group, n = 134). We recorded the incidence of postoperative nausea and vomiting (PONV), severity of nausea, incidence of antiemetic requirement, complete response, pain level, and opioid consumption. Patients were assessed 0 to 6, 6 to 24, 24 to 48, and 48 to 72 hours postoperatively. In addition, patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery. Results The Dexa-Ra group had a lower incidence of PONV during the entire 72-hour evaluation period and experienced less severe nausea for the first 6 hours after TKA, although not between 6 to 72 hours.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

Koh

Chang

Lee

et al. 2013

Clinical Orthopaedics &Amp; Related Research

118

147

View full text Add to dashboard Cite

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“…6 Methylprednisolone, the steroid administered to patients in the 2 groups in this study, has been shown to decrease late PONV extending to 24 hours and beyond. 35,36 …”

Section: Discussionmentioning

confidence: 99%

Postdischarge Nausea and Vomiting Remains Frequent After Le Fort I Osteotomy Despite Implementation of a Multimodal Antiemetic Protocol Effective in Reducing Postoperative Nausea and Vomiting

Brookes

Turvey

Phillips

et al. 2015

Journal of Oral and Maxillofacial Surgery

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Purpose To assess the prevalence of postdischarge nausea and vomiting (PDNV) after Le Fort I osteotomy with and without the use of a multimodal antiemetic protocol shown to decrease postoperative nausea and vomiting (PONV). Materials and Methods Consecutive patients undergoing Le Fort I osteotomy with or without additional procedures at a single academic institution formed the intervention cohort for an institutional review board–approved prospective clinical trial with a retrospective comparison group. The intervention cohort was managed with a multimodal antiemetic protocol. The comparison group consisted of consecutive patients who underwent similar surgical procedures at the same institution before protocol implementation. All patients were asked to complete a postdischarge diary documenting the occurrence of nausea and vomiting. Those who completed the diaries were included in this analysis. Data were analyzed with the Fisher exact test and the Wilcoxon rank sum test. A P value less than .05 was considered significant. Results Diaries were completed by 85% of patients in the intervention group (79 of 93) and 75% of patients in the comparison group (103 of 137). Patients in the intervention (n = 79) and comparison (n = 103) groups were similar in the proportion of patients with validated risk factors for PDNV, including female gender, history of PONV, age younger than 50 years, opioid use in the postanesthesia care unit (PACU), and nausea in the PACU (P = .37). The prevalence of PDNV was unaffected by the antiemetic protocol. After discharge, nausea was reported by 72% of patients in the intervention group and 60% of patients in the comparison group (P = .13) and vomiting was reported by 22% of patients in the intervention group and 29% of patients in the comparison group (P = .40). Conclusion Modalities that successfully address PONV after Le Fort I osteotomy might fail to affect PDNV, which is prevalent in this population. Future investigation will focus on methods to minimize PDNV.

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“…A cohort study employing an equivalent dose of methylprednisolone in patients undergoing total hip and knee surgery reported a statistically significant reduction in nausea and prevention of vomiting, supporting our notion that dexamethasone is most likely the most effective glucocorticoid used to prevent PONV. 25 …”

Section: Pro: Dexamethasone Anaesthesiologic Point Of Viewmentioning

confidence: 99%

Low-dose dexamethasone during arthroplasty

et al. 2016

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Dexamethasone is commonly applied during arthroplasty to control post-operative nausea and vomiting (PONV). However, conflicting views of orthopaedic surgeons and anaesthesiologists regarding the use of dexamethasone raise questions about risks of impaired wound healing and surgical site infections (SSI).The aim of this systematic review is to determine the level of evidence for the safety of a peri-operative single low dose of dexamethasone in hip and knee arthroplasty.We systematically reviewed literature in PubMed, EMBASE and Cochrane databases and cited references in articles found in the initial search from 1980 to 2013 based on predefined inclusion criteria. The review was completed with a ‘pro’ and ‘con’ discussion.After identifying 11 studies out of 104, only eight studies met the inclusion criteria. In total, 1335 patients were studied without any incidence of SSI. Causes of SSI are multifactorial. Therefore, 27 205 patients would be required (power = 90%, alpha = 0.05) to provide substantiated conclusions on safety of a single low dose of dexamethasone.Positively, many studies demonstrated showed convincing effects of low-dose dexamethasone on prevention of PONV and dose-dependent effects on post-operative pain and quality of recovery. Dexamethasone induces hyperglycaemia, but none of the studies demonstrated a concomitant SSI.Conversely, animal studies showed that high dose dexamethasone inhibits wound healing.A team approach of anaesthesiologists and orthopaedic surgeons is mandatory in order to balance the risk–benefit ratio of peri-operatively applied steroids for individual arthroplasty patients.We did not find evidence that a single low dose of dexamethasone contributes to SSI or wound healing impairment from the current studies.Cite this article: Wegener JT, Kraal T, Stevens MF, Hollman MW, Kerkhoffs GMMJ, Haverkamp D. Low-dose dexamethasone during arthroplasty: what do we know about the risks? EFORT Open Rev 2016;1:303-309. DOI: 10.1302/2058-5241.1.000039.

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Methylprednisolone reduces postoperative nausea in total knee and hip arthroplasty

Abstract: In total knee and hip arthroplasty, methylprednisolone is effective in preventing postoperative nausea; however, higher doses of methylprednisolone may be needed to prevent vomiting.

Cited by 31 publications

References 16 publications

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

Postdischarge Nausea and Vomiting Remains Frequent After Le Fort I Osteotomy Despite Implementation of a Multimodal Antiemetic Protocol Effective in Reducing Postoperative Nausea and Vomiting

Low-dose dexamethasone during arthroplasty

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