The AAHKS Clinical Research Award: Oral Dexamethasone Following Total Knee Arthroplasty: A Double-Blind, Randomized Controlled Trial.

Autor: Shaw JH; Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan., Wesemann LD; Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan., Banka TR; Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan., North WT; Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan., Charters MA; Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan., Davis JJ; Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2023 Jul; Vol. 38 (7 Suppl 2), pp. S15-S20. Date of Electronic Publication: 2023 Apr 25.
DOI: 10.1016/j.arth.2023.04.046
Abstrakt: Background: Intravenous dexamethasone has been shown to reduce pain in total joint arthroplasty. This double-blind, randomized, placebo-controlled trial investigated the postoperative effects and safety of oral dexamethasone as a potential augment to multimodal pain management in outpatient knee arthroplasty.
Methods: The authors prospectively randomized 109 consecutive patients undergoing primary total knee arthroplasty. Patients assigned to Group A (57 patients) received 4 mg of dexamethasone by mouth twice per day starting postoperative day (POD) 1 for 4 days and those assigned to Group B received placebo capsules. All healthcare professionals and patients were blinded to group allocation. The primary outcome was defined as postoperative pain scores. Secondary outcomes included 90-day postoperative complications, nausea and vomiting, daily opioid usage, assistance for ambulation, difficulty sleeping, and early patient reported outcomes. Demographics were similar between groups.
Results: The patients who received dexamethasone had a statistically significant decrease in VAS scores when averaging POD 1 to 4 (P = .01). The average VAS scores among individual days were significantly lower with dexamethasone on POD 2, 3, and 4. While taking dexamethasone, morning and mid-day VAS scores were significantly lower. There was no difference between the groups with opioid use, nausea or vomiting, 90-day complications, ability to walk with/without assistance, difficulty sleeping, and early patient reported outcomes.
Conclusion: This double-blind, randomized, placebo-controlled trial demonstrated that oral dexamethasone following primary total knee arthroplasty can reduce postoperative pain. This may be a beneficial option in ambulatory surgery where intravenous limitations exist, but larger series are needed to further evaluate the safety profile in this population.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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