Second Dose of Dexamethasone Reduces Postoperative Opioid Consumption and Pain in Total Joint Arthroplasty

The optimal administration of dexamethasone for postoperative pain management and recovery following primary elective total joint arthroplasty (TJA) remains unclear.

J. Arraut et al conducted a study to evaluate the effect of a second intravenous (IV) dose of dexamethasone on postoperative pain scores, inpatient opioid consumption, and functional recovery after total hip arthroplasty (THA) and total knee arthroplasty (TKA).

A retrospective review was conducted of 2,256 primary elective THAs and 1,951 primary elective TKAs between May 2020 and April 2021. Patients who received 2 perioperative doses (2D) of dexamethasone 10 mg IV were propensity-matched 1:1 to a control group who received 1 perioperative dose (1D). Primary outcomes were opiate consumption as morphine milligram equivalences (MMEs), postoperative pain as Verbal Rating Scale (VRS) pain scores, and functional status assessed by the Activity Measure for Post-Acute Care (AM-PAC) scores.

The key findings of the study were:

• The 2D THA and 2D TKA cohorts consumed significantly less opiates at the 24 to 48-hour and 48 to 72-hour intervals.

• The 2D TKA cohort had significantly lower total opiate consumption compared to the 1D TKA cohort.

• Compared to the 1D cohorts, the 2D THA cohort and 2D TKA cohorts had significantly lower pain scores at the 48 to 60-hour interval; additionally, the 2D TKA cohort had significantly lower pain scores in the 36 to 48-hour interval.

• AM-PAC scores did not differ between cohorts for both TKA and THA at any interval.

The authors concluded that – “A second 10 mg perioperative dose of dexamethasone is a safe and cost-effective treatment to help reduce opioid consumption and improve in-hospital metrics following elective hip and knee arthroplasty. Compared to a single 10 mg dexamethasone dose, a second dose reduced perioperative pain, lowered inpatient opioid consumption, but maintained functional recovery for both THA and TKA patients. Although additional research is necessary to delineate the long-term safety and efficacy of two 10 mg perioperative dexamethasone doses compared to other perioperative dosages, our findings may be useful for current TJA programs aiming to optimize postoperative pain management and improve quality of care.”

Level III Evidence: Retrospective Cohort Study

Further reading:

The AAHKS Best Podium Presentation Research Award: A Second Dose of Dexamethasone Reduces Postoperative Opioid Consumption and Pain in Total Joint Arthroplasty

Jerry Arraut, Jeremiah Thomas et al

The Journal of Arthroplasty 2023

https://doi.org/10.1016/j.arth.2023.02.007