Dexamethasone may help reduce post total knee arthroplasty morphine requirement, study finds

Denmark: In a new study conducted by Kasper Smidt Gasbjerg and team, it was found that two doses of dexamethasone help in reducing morphine consumption during 48 hours after total knee arthroplasty and reduced postoperative pain. The findings of this study were published in the British Medical Journal.

The procedure of total knee arthroplasty is very prevalent. More than a million treatments are performed annually around the world, and this number is predicted to rise dramatically as the world's population ages. Moderate to severe postoperative discomfort is common following the operation. As a result, the goal of this study was to look at the effects of one and two doses of intravenous dexamethasone in patients who had total knee arthroplasty.

This was a randomized, blinded, placebo-controlled trial with a 90-day follow-up period. This study took place in five Danish hospitals from September 2018 to March 2020. researchers received and analyzed data from 485 adult individuals who had total knee arthroplasty. Participants were randomly assigned to one of three groups using a computer-generated randomized sequence stratified by site: DX1 (dexamethasone (24 mg)+placebo); DX2 (dexamethasone (24 mg)+dexamethasone (24 mg)); or placebo (placebo + placebo). Preoperatively and after 24 hours, the intervention was provided. The investigators, participants, and outcome assessors were all blinded. Paracetamol, ibuprofen, and local infiltration analgesia were given to all of the subjects.

The key findings are as follow:

1. A total of 485 people were randomly assigned to one of three groups: 161 to DX1, 162 to DX2, and 162 to placebo.

2. The primary outcome analysis includes data from 472 individuals (97.3%). DX1 37.9 mg; DX2 35.0 mg; and placebo 43.0 mg were the median (interquartile range) morphine consumptions from 0 to 48 hours.

3. Between DX1 and DX2, the median differences were 2.7 mg, 7.8 mg between DX1 and placebo; and 10.7 mg, between DX2 and placebo.

4. One dosage of dexamethasone was given 24 hours after surgery, and two doses were given 48 hours after surgery.

In conclusion, after total knee arthroplasty, two doses of dexamethasone as an adjuvant to multimodal pain treatment with paracetamol, ibuprofen, and local infiltration analgesia reduced morphine consumption and pain.

Reference:

Gasbjerg K S, Hägi-Pedersen D, Lunn T H, Laursen C C, Holmqvist M, Vinstrup L /span> et al. Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial BMJ 2022; 376 :e067325 doi:10.1136/bmj-2021-067325