Low-dose dexamethasone may provide pain relief, improve mobility after TKA
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Key takeaways:
- Administration of low-dose IV dexamethasone before knee arthroplasty may improve patient outcomes for pain, vomiting, inflammation and mobility.
- Outcomes were compared with those of a placebo group.
Published results showed a single preoperative IV dose of 8 mg of dexamethasone may improve patient outcomes for pain, vomiting, inflammation and mobility after total knee arthroplasty compared with placebo.
Mohammed Anter Abdelhameed, from the orthopedic and traumatology department at Assiut University Hospital in Egypt, and colleagues performed a randomized, double-blinded, placebo-controlled trial of 86 patients (mean age, 59 years) who underwent primary TKA for osteoarthritis between October 2019 and February 2021.
The intervention group consisted of 43 patients who received an 8 mg IV dose of dexamethasone (Amriya Pharmaceuticals Industries), while the control group consisted of 43 patients who received a single 2 mL IV dose of saline. According to the study, the doses for both groups were administered after anesthesia but before surgery by an anesthesiologist.
Overall, outcomes were assessed at the first 3 postoperative days and on postoperative day 14. Outcomes included VAS scores for pain, VAS scores for postoperative nausea and vomiting (PONV), functional and mobility testing and wound complications.
Compared with the control group, the dexamethasone group reported lower VAS pain scores at rest and walking at all postoperative follow-up timepoints. In addition, the dexamethasone group reported fewer vomiting episodes on postoperative days 1 (P = .195) and 2 (P = .747). However, Abdelhameed and colleagues found no differences between the groups for PONV scores.
Abdelhameed and colleagues found the dexamethasone group had significantly lower timed up-and-go test scores on postoperative days 1 (P = .029) and 2 (P = .016) and significantly better quadriceps muscle strength on postoperative days 2 (P = .042) and 3 (P = .019) compared with the control group. They also noted serum C-reactive protein levels were significantly lower in the dexamethasone group at all postoperative follow-up timepoints except on postoperative day 3 compared with the control group.
“Although our perioperative pain management protocol did not include periarticular cocktail injection or postoperative opioid prescription, administration of a single low-dose IV [dexamethasone] DXA for primary TKA patients had a significant reducing effect on early postoperative pain,” Abdelhameed and colleagues wrote in the study.
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