Dexamethasone given intravenously may reduce pain after TKA
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Published results showed use of IV dexamethasone may be a useful adjunct for controlling pain in patients undergoing total knee arthroplasty.
Nattapol Tammachote, MD, MSc, and colleagues randomly assigned 100 patients who underwent unilateral TKA to receive either 0.15 mg/kg of IV dexamethasone (n=50) or saline placebo (n=50). Researchers considered pain level determined by VAS and the amount of morphine consumption 48 hours or less postoperatively as the primary outcomes, while secondary outcomes included rates of nausea and vomiting, C-reactive protein concentrations and functional outcomes.
At 12, 15, 18 and 21 hours postoperatively, results showed a significantly lower mean VAS score both at rest and during motion in the dexamethasone group. Researchers found a mean difference of –11 points and –15 points in pain at rest and pain during motion, respectively, at 21 hours postoperatively. According to results, 58% of patients in the dexamethasone group experienced nausea and vomiting vs. 84% of patients in the saline placebo group. Patients in the dexamethasone group also had lower levels of mean C-reactive protein, researchers found. At 3-month follow-up, researchers noted no significant differences in mean morphine consumption by 48 hours, modified WOMAC osteoarthritis index scores and range of motion of the knee between the two groups.
“Dexamethasone had not only an antiemetic effect, but it also had an analgesic effect to control pain after TKA for nearly a day,” Tammachote told Healio Orthopedics. “This drug is a good option to be used to control pain after TKA ,especially in patients who had kidney disease.” – by Casey Tingle
Disclosure: Tammachote reports no relevant financial disclosures.
Perspective
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Brian J. McGrory, MD, MS
Nattapol Tammachote, MD, MSc, and Supakit Kanitnate, MD, reinforce the growing body of literature supporting the use of perioperative glucocorticoids for enhanced outcomes for TKA in their study. Dexamethasone, a long-acting glucocorticoid that is increasingly used as part of multimodal pain protocols for joint replacement surgery, was studied in a well-designed and well-executed single-center, single-surgeon, double-blind randomized controlled trial. The authors focused on the analgesic effects of 0.15 mg/kg of dexamethasone (maximum dosage, 12 mg) given intravenously, after spinal anesthesia was administered, but prior to surgery.
They found that dexamethasone reduced pain significantly between 12 and 21 hours after TKA, both at rest and during motion. The dexamethasone group also had lower rates of nausea and vomiting and a lower mean C-reactive protein level. As in the other literature that the authors summarize in their manuscript, there were no differences in wound complications or infections between the control group and the study cohort receiving this powerful anti-inflammatory and immune system modulator.
Larger studies are now warranted to discern differences in rare complications, such as infection, but this report is encouraging for early patient recovery after total knee replacement. Repeat dexamethasone dosing after 24 hours, which has been previously supported by another randomized controlled trial, may be useful in extending the benefit shown in the current study to aid in rebound pain after a peripheral nerve block wears off.
References:
Backes JR, et al. J Arthroplasty. 2013;doi:10.1016/j.arth.2013.05.041.
Tammachote N, et al. J Arthroplasty. 2020;doi:10.1016/j.arth.2019.09.002.
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