Second dose of IV dexamethasone reduced pain associated with TKA
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GRAPEVINE, Texas — Results showed patients undergoing total knee arthroplasty who received two perioperative doses of dexamethasone had significantly lower overall inpatient opiate consumption compared with patients who received one dose.
In addition, patients who received two doses of IV dexamethasone had significantly reduced pain scores at 36 to 60 hours postoperatively vs. patients who received one dose, according to Joshua C. Rozell, MD, of NYU Langone Health.
“Based on our data, a second dose of dexamethasone following TKA is safe and effective in reducing pain [and] length of stay and doesn’t have a negative impact on reoperations, readmissions and complications, or even functional outcomes,” Rozell said at the American Association of Hip and Knee Surgeons Annual Meeting, here.
Because the optimal dosing of perioperative IV dexamethasone for TKA is unclear in the literature, Rozell and colleagues sought to better understand its effect on pain scores, opioid consumption and function among patients undergoing TKA who received one vs. two doses.
Researchers studied a control group of 399 patients at their institution who received one-dose IV dexamethasone under the protocol used through 2021 who were propensity-matched 1:1 with 399 patients who received two doses of IV dexamethasone.
All patients received a first dose of 10-mg IV dexamethasone in the OR before incision. The two-dose group received a second dose of dexamethasone postoperatively either in the post-anesthesia care unit, for patients who went home the day of surgery, or on Postoperative Day 1 for patients who stayed overnight.
Researchers analyzed primary outcomes of in-hospital opioid consumption converted into morphine milligram equivalents (MMEs), pain measured with the verbal rating scale (VRS) and activity assessed with activity measure for post-acute care (AM-PAC) scores. Secondary outcomes included discharge disposition, length of stay and 90-day outcomes, such as readmissions, complications and reoperations.
“Patients in the two-dose group had significantly decreased pain scores in 36 to 60 hours postop. Opioid use was also significantly decreased between 1 and 3 days postop and overall for the two-dose group. However, we didn’t see any differences in the AM-PAC scores between groups in the immediate postoperative period,” Rozell said.
According to the abstract, inpatient opiate consumption was 33.4 (± 59.3) MME in the two-dose group vs. 54.2 (± 119) MME in the control group, which represented a 38.4% decrease in consumption for the two-dose group. Postoperative VRS pain scores for the two-dose group were lower at 36 to 48 hours at 4.70 (± 2.03) vs. the control group at 5.27 (± 1.84), as well as at 48 to 60 hours at 4.71 (± 2.07) vs. 5.50 (± 2.08) in the control group.
“Importantly, patients in the two-dose group had decreased length of stay compared to the one-dose group, without any adverse effects on 90-day complications,” Rozell said.
Length of hospital stay was 1.61 (± 1.21) days in the two-dose group vs. 1.87 (± 2.34) days in the control group, according to the abstract.
The rate of discharge to home was similar between the groups, he said.
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Arraut J, et al. Paper 28. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 3-6, 2022; Grapevine, Texas.
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