Oral dexamethasone following primary TKA can reduce postoperative pain

The double-blind, randomized, placebo-controlled trial by J.H. Shaw et al investigated the postoperative effects and safety of oral dexamethasone as a potential augment to multimodal pain management in outpatient knee arthroplasty.

The study was conducted at Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan. This study has been awarded – ‘The AAHKS Clinical Research Award’ and published in ‘The Journal of Arthroplasty.’

Multimodal pain protocols have become standard in orthopaedics for enhanced recovery after surgery to aid in early postoperative discharge as well as decrease opioid utilization in patients undergoing total joint arthroplasty. Intravenous (IV) dexamethasone has been shown to be a safe and effective medication to decrease postoperative pain as well as nausea and vomiting following an orthopaedic procedure.

The authors prospectively randomized 109 consecutive patients undergoing primary total knee arthroplasty. Patients assigned to Group A (57 patients) received 4 mg of dexamethasone by mouth twice per day starting postoperative day (POD) 1 for 4 days and those assigned to Group B received placebo capsules. All healthcare professionals and patients were blinded to group allocation. The primary outcome was defined as postoperative pain scores. Secondary outcomes included 90-day postoperative complications, nausea and vomiting, daily opioid usage, assistance for ambulation, difficulty sleeping, and early patient reported outcomes. Demographics were similar between groups.

Key findings of the study were:

• The patients who received dexamethasone had a statistically significant decrease in VAS scores when averaging POD 1 to 4 (P ¼ .01).

• The average VAS scores among individual days were significantly lower with dexamethasone on POD 2, 3, and 4.

• While taking dexamethasone, morning and mid-day VAS scores were significantly lower.

• There was no difference between the groups with opioid use, nausea or vomiting, 90-day complications, ability to walk with/without assistance, difficulty sleeping, and early patient reported outcomes.

The authors concluded that – “This double-blind, randomized, placebo-controlled trial demonstrated that oral dexamethasone following primary total knee arthroplasty can reduce postoperative pain. This may be a beneficial option in ambulatory surgery where intravenous limitations exist, but larger series are needed to further evaluate the safety profile in this population.”

Further reading:

The AAHKS Clinical Research Award: Oral Dexamethasone Following Total Knee Arthroplasty: A Double-Blind, Randomized Controlled Trial

J.H. Shaw et al.

The Journal of Arthroplasty (2023)

https://doi.org/10.1016/j.arth.2023.04.046