Dexamethasone Administration reduces pain without disturbing blood sugar After TKA in Type 2 Diabetes Patients: Study
Researchers in a new study has found that the administration of DXM after unilateral total knee arthroplasty (TKA) can effectively reduce postoperative pain and suppress the occurrence of postoperative nausea and vomiting (PONV) without affecting postprandial blood glucose (PBG) in patients with type 2 diabetes.Additionally, the preoperative level of glycated hemoglobin can accurately predict PBG. The study was conducted by Chen J. and colleagues published in the journal of Orthopaedic Surgery. This study aimed to assess the effect of DXM on PBG and postoperative recovery in patients with diabetes mellitus undergoing TKA.
This was a retrospective analysis of 285 patients with type 2 diabetes and advanced knee osteoarthritis who were operated on bilaterally at the Joint Surgery Center of Peking University Third Hospital from January 2019 to November 2022. After exclusion and inclusion criteria, 161 patients were included in this study. The patients were distributed into two groups: whether they received continuous intravenous administration of DXM for three days after the surgery or not.
• DXM group (n = 66)
• Non-DXM group (n = 95)
All other perioperative treatments and medications were the same for both groups. The investigators assessed postoperative pain scores, the incidence of postoperative nausea and vomiting (PONV), length of hospital stay, PBG levels, and other clinical data.
Results
• There was no difference between the DXM and non-DXM groups for any preoperative characteristics. Key findings were as follows:
• PBG Levels: The average of PBG levels was comparable (10.84 mg/dL vs. 11.05 mg/dL), and the rate of patients with PBG larger than 200 mg/dL was comparative (43.2% vs. 43.9%).
• Pain Scores: Comparison of postoperative VAS scores between DXM and non-DXM groups, the latter had higher values (2.48 vs. 3.67).
• PONV Rates: The cumulative incidence of PONV was significantly less in the DXM group (16% vs. 40%).
• Prediction of PBG: Preoperative glycated hemoglobin levels have been shown to predict the actual PBG.
• Early postoperative complications were not significantly different between groups.
The study authors concluded that dexamethasone significantly reduces pain and PONV without having a clinically relevant effect on blood glucose levels in patients with type 2 diabetes undergoing TKA. Preoperative glycated hemoglobin levels are an accurate predictor of perioperative blood glucose trends. These findings highlight the potential use of DXM as a useful adjunct to ERAS protocols in diabetic patients undergoing joint replacement surgeries.
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