Oral dexamethasone following primary TKA can reduce postoperative pain

Written By : Dr Supreeth D R |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-08-08T09:30:58+05:30 | Updated On 8 Aug 2023 12:57 PM IST

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.”

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751