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

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 72h 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 72h (P=0.017, P=0.031) postoperatively and Group B at 24h (P=0.027, P=0.019) postoperatively. Pain were significantly less in Group C than Group A at 24 (P<0.001), 48h (P=0.037) postoperatively and Group B 24h (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 10mg dexamethasone 1h before the surgery, and repeated at 6h 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.