Dose optimization of intravenous dexamethasone for total knee arthroplasty: when two is not better than one.

Abstract

BACKGROUND:

The optimal dose regimen of dexamethasone in total knee arthroplasty (TKA) has not been determined. This study was performed to evaluate the impact of a single preoperative high-dose dexamethasone compared with two perioperative low-dose dexamethasone in TKA.

MATERIALS AND METHODS:

We prospectively studied three regimens on dexamethasone: no dexamethasone (A), a single preoperative dose of 20-mg dexamethasone (B), and two perioperative doses of 10-mg dexamethasone (C). The primary outcome was postoperative pain level. The incidence of postoperative nausea and vomiting (PONV), use of analgesic and antiemetic rescue, interleukin-6 (IL-6) and C-reactive protein (CRP) levels, range of motion (ROM), and complications were also compared.

RESULTS:

The dynamic pain scores and CRP and IL-6 levels were significantly lower for Group B compared to Groups A and C on postoperative days 1 and 2 (POD 1 and 2). Such differences were also detected between Groups C and A. Besides, the pain scores at rest were significantly lower in Groups B and C than in Group A on POD 1 and 2. Patients in Groups B and C had a lower incidence of PONV, reduced use of analgesic and antiemetic rescue, and improved ROM than in Group A. No complications occurred in any group.

CONCLUSION:

Dexamethasone in TKA provides short-term advantages in analgesic, antiemetic and anti-inflammatory effects. Besides, regarding the effects of pain and inflammatory control on POD 1 and 2, a single preoperative high dose of 20-mg dexamethasone was more effective than two perioperative low doses of 10-mg dexamethasone.

LEVEL OF EVIDENCE:

I.

• Authors: Yiting Lei, Zeyu Huang, Qiang Huang, Fuxing Pei, Wei Huang
• Journal: Archives of orthopaedic and trauma surgery (Arch Orthop Trauma Surg) Vol. 142 Issue 4 Pg. 665-672 (Apr 2022) ISSN: 1434-3916 [Electronic] Germany
• PMID: 33743063 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Chemical References

• Analgesics
• Anti-Inflammatory Agents
• Antiemetics
• Dexamethasone

Topics

• Analgesics (administration & dosage, therapeutic use)
• Anti-Inflammatory Agents (administration & dosage, therapeutic use)
• Antiemetics (administration & dosage, therapeutic use)
• Arthroplasty, Replacement, Knee (adverse effects)
• Dexamethasone (administration & dosage, therapeutic use)
• Humans
• Pain, Postoperative (drug therapy, prevention & control)
• Postoperative Nausea and Vomiting (drug therapy, prevention & control)