Perioperative multiple low-dose Dexamethasones improves postoperative clinical outcomes after Total knee arthroplasty

Abstract

BackgroundThe purpose of this study was to investigate the efficacy and safety of multiple low-dose dexamethasones in primary total knee arthroplasty (TKA).MethodsOne hundred fifty patients were equally randomized into 3 groups: Group A (n = 50) received 2 doses of normal saline only; Group B (n = 50) received with 1 dose of intravenous dexamethasone and 1 dose of normal saline; Group C (n = 50) received with 2 doses of intravenous dexamethasone. The clinical outcomes and complications were assessed.ResultsThe CRP and IL-6 were significantly lower in Group C and B than Group A at 24, 48, and 72 h postoperatively (P < 0.001 for all). The intensity of postoperative nausea and vomiting (PONV) in Group C was lower than Group A at 24 (P < 0.001, P = 0.002), 48 (P = 0.005, P = 0.041) and 72 h (P = 0.017, P = 0.031) postoperatively and Group B at 24 h (P = 0.027, P = 0.019) postoperatively. Pain were significantly less in Group C than Group A at 24 (P < 0.001), 48 h (P = 0.037) postoperatively and Group B 24 h (P = 0.030) postoperatively. Patients in Group C had better range of motion (ROM) and satisfaction than Group A (P < 0.001, P = 0.002) and B (P = 0.001, P = 0.043). No differences were found in complications.ConclusionsThe administration of 10 mg dexamethasone 1 h before the surgery, and repeated at 6 h postoperatively can significantly reduce the level of postoperative CRP and IL-6 and the incidence of PONV, relieve pain, achieve an additional analgesic effect, and improve the early ROM compared with the other two groups in TKA.Level of EvidenceTherapeutic Level I.Trial registrationThe Chinese Clinical Trial Registry (ChiCTR1800017036). Registered on July 9, 2018.

The role of perioperative intravenous low-dose dexamethasone in rapid recovery after total knee arthroplasty: a meta-analysis

“…Among these, 109 duplicates were excluded using Endnote X8 (Clarivate, Philadelphia, PA, USA), and 250 studies were removed on the basis of the title and abstract. Ten files 14 – 18 , 23 – 27 that met the inclusion criteria were ultimately identified after carefully and completely reading each of the 19 remaining studies. The specific process of including studies is shown in Figure 1 .…”

“…A pain VAS following TKA was reported in nine studies. 14 – 18 , 23 – 26 All of these nine studies assessed VAS at 24 hours, 14 – 18 , 23 – 26 and the VAS at 48 hours was evaluated in six studies. 15 – 17 , 23 – 25 The pooled results demonstrated that perioperative intravenous low-dose dexamethasone decreased the postoperative pain score at 24 hours (SMD = −0.430; 95%CI: −0.570 to −0.291; P < 0.001) and 48 hours (SMD = −0.250; 95%CI: −0.405 to −0.096; P = 0.002).…”

“…Four studies 14 , 15 , 18 , 26 provided ROM data at 72 hours after TKA. Among these four studies, three 14 , 15 , 26 assessed passive ROM at 72 hours, and one study 18 assessed active ROM at 72 hours. The overall results showed that intravenous low-dose dexamethasone improved the active ROM (SMD = 1.254; 95%CI: 0.573 to 1.935; P < 0.001) and passive ROM (SMD = 0.371; 95%CI: 0.152 to 0.589; P = 0.001).…”

“…Additionally, the sample size in previous meta-analyses was also small, and they did not report postoperative knee ROM, which was an important parameter for early postoperative recovery. Furthermore, new high-quality randomized controlled trials (RCTs) 14 , 15 , 17 have been published with seemingly mixed results. Two RCTs 16 , 18 that were written in Chinese were not part of the previous reviews, which caused publication bias and statistical bias.…”

Opioid Use Is Reduced in Patients Treated with NSAIDs After Arthroscopic Bankart Repair: A Randomized Controlled Study

“… 23 , 24 , 25 Additionally, recent investigations into various non-narcotic perioperative medications have shown the potential to further reduce a patient’s overall need for pain medicine in the immediate postoperative period and improve outcomes. 19 , 26 , 27 …”