Dexamethasone decreased opioid use, improved pain after shoulder arthroplasty
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Use of dexamethasone decreased anti-emetic and opioid use and improved pain control in patients undergoing shoulder arthroplasty, according to results presented at the American Shoulder and Elbow Surgeons Annual Meeting.
Stephanie J. Muh, MD, and colleagues randomly assigned 91 patients undergoing shoulder arthroplasty to receive either 10 mg of IV dexamethasone within 90 minutes of surgery (n=47) or no dexamethasone (n=45). Muh noted all patients received a standard postoperative multimodal pain regimen and 4 mg of ondansetron for nausea and vomiting as needed.
“Our primary outcome was 24-hour VAS scores, morphine equivalent use and inpatient anti-emetic use,” Muh said in her presentation. “Secondary outcomes included patient-reported postoperative nausea, length of hospital stay and complications.”
Patients in the dexamethasone group used significantly less ondansetron for postoperative nausea during the first 24 hours, according to Muh. She added patients in the dexamethasone group had a significant decrease in VAS scores at all time points.
“Morphine equivalent use was significantly lower in the dexamethasone group compared to controls at 12 and 16 hours, as well as 16 to 20 hours,” Muh said. “When averaged over the first 24 hours, morphine equivalent was also significantly lower in the dexamethasone group.”
Although the dexamethasone group had a higher preoperative glucose, Muh noted no statistically significant difference between the groups. The dexamethasone group also did not have significant glucose elevation postoperatively, Muh said.
“There was no significant difference in the length of hospital stay and follow-up, including 3 to 18 months, showed there were two infections, one in each group, as well as two reoperations, one in each group,” Muh said.
Perspective
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Howard Routman, DO, FAOAO
Muh and colleagues’ paper on the use of a single dose of IV dexamethasone in shoulder arthroplasty should encourage us to take note and consider adding this to our multimodal approach for patients undergoing this procedure. This information could not be more timely, as we are seeing more shoulder arthroplasty being done in the outpatient setting, where uncontrolled pain and nausea postoperatively can complicate an otherwise smooth episode of care. Previous anecdotal reports have been supportive of this approach, but this randomized trial further reinforces the efficacy of this technique.
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Klag EA, et al. Dexamethasone improves postoperative pain and nausea after total shoulder arthroplasty: A prospective, randomized controlled trial. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 2-3, 2020 (virtual meeting).
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