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

被引:14
作者
Lei, Yiting [1 ,2 ]
Huang, Zeyu [2 ]
Huang, Qiang [2 ]
Pei, Fuxing [2 ]
Huang, Wei [1 ]
机构
[1] Chongqing Med Univ, Affiliated Hosp 1, Dept Orthoped, Chongqing 400016, Peoples R China
[2] Sichuan Univ, West China Hosp, Dept Orthoped, 37 WainanGuoxue Rd, Chengdu 610041, Peoples R China
关键词
Total knee arthroplasty; Dexamethasone; Dose optimization; Randomized controlled study;
D O I
10.1007/s00402-021-03859-3
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
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.
引用
收藏
页码:665 / 672
页数:8
相关论文
共 31 条
  • [1] Dexamethasone Reduces Length of Hospitalization and Improves Postoperative Pain and Nausea After Total Joint Arthroplasty A Prospective, Randomized Controlled Trial
    Backes, Jeffrey R.
    Bentley, Jared C.
    Politi, Joel R.
    Chambers, Bryan T.
    [J]. JOURNAL OF ARTHROPLASTY, 2013, 28 (08) : 11 - 17
  • [2] Bian, 2021, NANO LETT
  • [3] The Impact of Postoperative Nausea and Vomiting Prophylaxis with Dexamethasone on Postoperative Wound Complications in Patients Undergoing Laparotomy for Endometrial Cancer
    Bolac, Corey S.
    Wallace, Amy H.
    Broadwater, Gloria
    Havrilesky, Laura J.
    Habib, Ashraf S.
    [J]. ANESTHESIA AND ANALGESIA, 2013, 116 (05) : 1041 - 1047
  • [4] Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Thyroidectomy: Meta-analysis of Randomized Controlled Trials
    Chen, Chia-Che
    Siddiqui, Fahad Javaid
    Chen, Ta-Liang
    Chan, Edwin Shih-Yen
    Tam, Ka-Wai
    [J]. WORLD JOURNAL OF SURGERY, 2012, 36 (01) : 61 - 68
  • [5] Risk factors for corticosteroid insufficiency during the sub-acute phase of acute traumatic brain injury
    Chen, Xin
    Chai, Yan
    Wang, Shao-Bo
    Wang, Jia-Chong
    Yue, Shu-Yuan
    Jiang, Rong-Cai
    Zhang, Jian-Ning
    [J]. NEURAL REGENERATION RESEARCH, 2020, 15 (07) : 1259 - 1265
  • [6] Pain monitoring and management in a rehabilitation setting after total joint replacement
    De Luca, Maria Laura
    Ciccarello, Marcello
    Martorana, Manfredi
    Infantino, Davide
    Mauro, Giulia Letizia
    Bonarelli, Stefano
    Benedetti, Maria Grazia
    [J]. MEDICINE, 2018, 97 (40)
  • [7] Perioperative Single Dose Systemic Dexamethasone for Postoperative Pain A Meta-analysis of Randomized Controlled Trials
    De Oliveira, Gildasio S., Jr.
    Almeida, Marcela D.
    Benzon, Honorio T.
    McCarthy, Robert J.
    [J]. ANESTHESIOLOGY, 2011, 115 (03) : 575 - 588
  • [8] Antiemesis After Total Joint Arthroplasty: Does a Single Preoperative Dose of Aprepitant Reduce Nausea and Vomiting?
    DiIorio, Timothy M.
    Sharkey, Peter F.
    Hewitt, Agnes M.
    Parvizi, Javad
    [J]. CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 2010, 468 (09) : 2405 - 2409
  • [9] Does Dexamethasone Reduce Hospital Readiness for Discharge, Pain, Nausea, and Early Patient Satisfaction in Hip and Knee Arthroplasty? A Randomized, Controlled Trial
    Dissanayake, Ravi
    Du, Hao Nan
    Robertson, Lain K.
    Ogden, Kathryn
    Wiltshire, Kaitlyn
    Mulford, Jonathan S.
    [J]. JOURNAL OF ARTHROPLASTY, 2018, 33 (11) : 3429 - 3436
  • [10] Increased postoperative dexamethasone and gabapentin reduces opioid consumption after total knee arthroplasty
    Eckhard, Lukas
    Jones, Todd
    Collins, Jamie E.
    Shrestha, Swastina
    Fitz, Wolfgang
    [J]. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 2019, 27 (07) : 2167 - 2172