Perioperative combined administration of tranexamic acid and dexamethasone in total knee arthroplasty—benefit versus harm?

Abstract

Background: The purpose of this study was to investigate the benefits and harm of combined administration of tranexamic acid (TXA) and dexamethasone (Dexa) in total knee arthroplasty (TKA). Methods: A total of 88 consecutive patients undergoing TKA for knee osteoarthritis were stratified in 2 groups. All surgeries were performed under general anesthesia. Brief, patients in the TXA + Dexa group (n = 45) received 10 mg Dexa just after the anesthesia, and repeated at 24 hours after the surgery; and patients in the TXA group (n = 43) received 2 ml of normal saline solution at the same time. The measured outcomes were the C-reactive protein (CRP) and interleukin-6 (IL-6) from preoperatively to postoperatively, and postoperative nausea and vomiting (PONV), fatigue, range of motion (ROM), length of stay (LOS), and the analgesic and antiemetic rescue consumption Results: The level of CRP and IL-6 in the TXA + Dexa group were lower than that in the TXA group at 24 hours ( P < .001, P < .001), 48 hours ( P < .001, P < .001), and 72 hours ( P < .001, P < .001) after the surgery. The pain scores in the TXA + Dexa group were lower during walking at 24 hours ( P < .001), 48 hours ( P < .001), and 72 hours ( P < .001) and at rest at 24 hours ( P = .022) after the surgery. Patients in the TXA + Dexa group had a lower nausea score, the incidence of PONV, fatigue, and the analgesic and antiemetic rescue consumption, and had a greater ROM than that in the TXA group. No significant differences were found in LOS and complications. Conclusion: The combined administration of TXA + Dexa significantly reduced the level of postoperative CRP and IL-6, relieve postoperative pain, ameliorate the incidence of POVN, provide additional analgesic and antiemetic effects, reduce postoperative fatigue, and improve ROM, without increasing the risk of complications in primary TKA.

Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial

“… 11 Our results concur with most previous, but smaller, trials for the effect of high dose (>20 mg dexamethasone equivalent) glucocorticoid on morphine consumption and pain scores. 10 34 35 36 37 38 39 This DEX-2-TKA low risk of bias trial shows a statistically and patient important adjuvant analgesic effect of two doses of high dose dexamethasone, and with follow-up at 90 days.…”

Tranexamic acid in total knee replacement and total hip replacement – a single-center retrospective, observational study

“…3,[12][13][14] Our results are in line with the results of other studies and meta-analyses. [1][2][3]6,[11][12][13][14][15][16][17][18][19][20] It is worth noting that the transfusion rates in the TXA group were even lower than in some of the previous reports. According to the meta-analysis by Kuo et al, in revision JRS, the transfusion rates can be as high as 15% with TXA and 38,7% in patients not receiving TXA.…”

A Comprehensive Single-Center Analysis of Postoperative Nausea and Vomiting Following Orthognathic Surgery

“…Although these scores may be useful for identifying PONV risk, there remains a need to optimize strategies for decreasing such risk. At our institution, we implement an extensive ERAS protocol for risk reduction that includes, in addition to anesthesia precautions (ie avoiding volatile anesthetics 18 ), antiemetic prophylaxis, administration of IV dexamethasone, 19,20 a tranexamic acid bolus following induction, 21 substantial IV hydration, 22 and packing removal and nasogastric suctioning before extubation to minimize ingestion of blood. 13 In addition to these precautions, the post hoc analyses in our study identified 2 additional measures for potentially decreasing PONV risk: more aggressive antiemetic prophylaxis, and decreased reliance on postoperative opioids.…”