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

Abstract

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.

Can intravenous steroid administration reduce postoperative pain scores following total knee arthroplasty?

“…Five studies involving 435 patients reported VAS scores after 24 hours of rest. [16,18–20,22] The pooled results indicated that IV steroids were associated with decreased VAS scores at 24 hours (MD = −10.21, 95%CI = −18.80 to −1.63, P  = .020, Fig. 4), and a high level of heterogeneity was identified ( I 2  = 95.9%, P  = .000).…”

Effect of Intravenous Corticosteroids on Pain Management and Early Rehabilitation in Patients Undergoing Total Knee or Hip Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

“…Two trials were excluded because they were not RCTs . Finally, 14 studies, with 542 patients in corticosteroid groups and 481 patients in control groups, were included in this meta‐analysis. The flow diagram is shown in Figure .…”

Perioperative intravenous glucocorticoids can decrease postoperative nausea and vomiting and pain in total joint arthroplasty

“…Randomized sequence generation was implemented adequately in 8 studies; [6,9,18,20–23,27] the other 5 studies had an unclear risk of bias. Allocation concealment was implemented adequately in all included studies.…”

“…Allocation concealment was implemented adequately in all included studies. [6,9,18,20–23,27] All studies reported blinding of the participants, personnel, and outcome assessors. [6,9,17–27] The overall kappa value regarding the evaluation of risk of bias of included RCTs was 0.913, indicating an excellent degree of agreement between the 2 authors.…”