Abstract
Background
Pain after total knee arthroplasty (TKA) affects postoperative recovery and patient
satisfaction. The analgesic benefits of corticosteroids have not been well studied.
We, therefore, investigated the analgesic effects of intravenous (IV) dexamethasone
(DEX) in patients undergoing a TKA.
Methods
This was a randomized, double-blind, placebo-controlled trial of 0.15 mg/kg of IV
DEX vs saline placebo in unilateral TKA. Fifty patients/arm were recruited. Primary
outcomes were pain level, determined by a visual analog scale, and the amount of morphine
consumption (mg) ≤48 hours post-TKA. Secondary outcomes were rates of nausea and vomiting,
C-reactive protein concentrations, and functional outcomes.
Results
The DEX group had a significantly lower mean visual analog scale score both at rest
and during motion at 12, 15, 18, and 21 hours (P < .05). At 21 hours, the mean difference (Δ) in pain at rest was −11 points (95%
confidence interval [CI], −21 to −2 points; P = .02) while the mean difference in pain during motion was −15 points (95% CI, −25
to −5 points; P = .004). The DEX group also had lower rates of nausea and vomiting: 29/50 (58%) vs
42/50 (84%) (P = .008) and lower mean C-reactive protein level: 89 vs 167, Δ = −78 mg/L (95% CI, −100
to −58 mg/L, P < .0001). There were no significant differences in mean morphine consumption by 48 hours,
modified Western Ontario and McMaster University Osteoarthritis Index scores, and
range of motion of the knee at 3-month follow-up (P > .05).
Conclusion
IV DEX relieves postoperative pain between 12 to 21 hours after TKA and may be a useful
adjunct for controlling pain in patients undergoing TKA.
Keywords
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Article info
Publication history
Published online: September 07, 2019
Accepted:
September 2,
2019
Received in revised form:
August 7,
2019
Received:
June 24,
2019
Footnotes
Investigation was performed at the Orthopedic unit, Thammasat University Hospital, Thammasat University, Pathumthani, Thailand.
No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.09.002.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
