Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial.

Abstract

BACKGROUND:

Total knee arthroplasty (TKA) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach, but the effect of high-dose glucocorticoid administration has not been studied.

METHODS:

Forty-eight patients undergoing unilateral TKA were included in a randomized, double-blind, placebo-controlled trial receiving preoperative methylprednisolone (MP) 125 mg i.v. or saline. All surgery was performed under lumbar spinal anaesthesia and patients received a standardized, multimodal analgesic regime. The primary endpoint was pain during walking 24 h after surgery, and secondary endpoints were pain at rest, pain upon hip flexion, and pain upon knee flexion. Pain assessments were performed repeatedly for the first 48 h after surgery, in a questionnaire from days 2 to 10, and at follow-up on days 21 and 30. Tertiary endpoints were postoperative nausea and vomiting (PONV), plasma C-reactive protein (CRP) concentrations, fatigue, sleep quality, and rescue analgesic and antiemetic requirements.

RESULTS:

Pain during walking was significantly lower in the MP group up to 32 h after operation. Overall pain and cumulative pain scores (2-48 h) were lower for all pain assessments (P<0.04). Consumption of rescue oxycodone was lower from 0 to 24 h (P=0.02) and PONV, consumption of ondansetron reduced (P<0.05), and CRP concentrations were lower at 24 h (P<0.000001). Fatigue throughout the day of surgery was lower (P=0.02), but sleep quality was worse on the first night (P=0.002). No side-effects or complications were observed in other respects.

CONCLUSIONS:

MP 125 mg before surgery improves analgesia and immediate recovery after TKA, even when combined with a multimodal analgesic regime. These findings call for further studies on safety aspects.

• Authors: T H Lunn, B B Kristensen, L Ø Andersen, H Husted, K S Otte, L Gaarn-Larsen, H Kehlet
• Journal: British journal of anaesthesia (Br J Anaesth) Vol. 106 Issue 2 Pg. 230-8 (Feb 2011) ISSN: 1471-6771 [Electronic] England
• PMID: 21131371 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Analgesics, Opioid
• Antiemetics
• Glucocorticoids
• C-Reactive Protein
• Oxycodone
• Methylprednisolone

Topics

• Aged
• Aged, 80 and over
• Analgesics, Opioid (administration & dosage)
• Anesthesia, Spinal (methods)
• Antiemetics (administration & dosage)
• Arthroplasty, Replacement, Knee (adverse effects, rehabilitation)
• C-Reactive Protein (metabolism)
• Double-Blind Method
• Drug Administration Schedule
• Female
• Glucocorticoids (administration & dosage, therapeutic use)
• Humans
• Male
• Methylprednisolone (administration & dosage, therapeutic use)
• Middle Aged
• Oxycodone (administration & dosage)
• Pain Measurement (methods)
• Pain, Postoperative (etiology, prevention & control)
• Postoperative Care (methods)
• Postoperative Nausea and Vomiting (prevention & control)
• Preanesthetic Medication