Dexamethasone facilitates post-operative recovery in arthroplasty patients: study
Perioperative corticosteroids are safe, facilitate earlier discharge, and improve patient recovery following unilateral total plaknee arthrosty and total hip arthroplasty, suggests recent findings from a study published in The Journal of Arthroplasty. Researchers further opined that higher doses (15-20 mg of dexamethasone) are associated with further reductions in dynamic pain and PONV, and repeat dosing may further reduce length of stay (LOS).
Dexamethasone, as a kind of antiemetics and potential analgesics, is such a simple and straightforward intervention to reduce PONV and relief pain to make arthroplasty patients from sick to well. However, there is still controversy whether dexamethasone contributes to postoperative recovery. Therefore, it is necessary to rely on evidence-based study to help the surgeon make correct clinical decisions.
With such understanding,The objective of this current review was to examine the effect of perioperative systemic corticosteroids at varying doses and timings on early postoperative recovery outcomes following unilateral total knee and total hip arthroplasty. The primary outcome was length of stay (LOS).
For the study design,A systematic review and meta-analysis of randomized controlled trials was performed. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception to June 1, 2020. Studies comparing the outcome of adult patients receiving a systemic steroid to patients who did not receive steroids were included.
Data analysis revealed the following facts.
· Seventeen studies were included, incorporating 1957 patients. Perioperative corticosteroids reduced hospital LOS (mean difference [MD] = −0.39 days, 95% confidence interval [CI] −0.61 to −0.18).
· A subsequent dose of corticosteroid at 24 hours further reduced LOS (MD = −0.33, 95% CI −0.55 to −0.11).
· Corticosteroids resulted in reduced levels of pain on postoperative day (POD) 0 (MD = −1.99, 95% CI −3.30 to −0.69), POD1 (MD = −1.47, 95% CI −2.15 to −0.79), and POD2.
· Higher doses were more effective in reducing pain with activity on POD0 ( P = .006) and 1 ( P = .023).
· Steroids reduced the incidence of PONV on POD1 (log odds ratio [OR] = −1.05, 95% CI −1.26 to −0.84) and POD2, with greater effect at higher doses ( P = .046). Corticosteroids did not increase the incidence of infection ( P = 1.000), venous thromboembolism ( P = 1.000), or gastrointestinal hemorrhage ( P = 1.000) but were associated with an increase in blood glucose (MD = 5.30 mg/dL, 95% CI 2.69-7.90).
For the full article follow the link: https://doi.org/10.1016/j.arth.2020.10.010
Primary source: The Journal of Arthroplasty