Clinical Orthopaedics and Related Research®

, Volume 471, Issue 9, pp 3010–3020

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

  • In Jun Koh
  • Chong Bum Chang
  • Jung Ha Lee
  • Young-Tae Jeon
  • Tae Kyun Kim
Clinical Research

DOI: 10.1007/s11999-013-3032-5

Cite this article as:
Koh, I.J., Chang, C.B., Lee, J.H. et al. Clin Orthop Relat Res (2013) 471: 3010. doi:10.1007/s11999-013-3032-5

Abstract

Background

Dexamethasone is a potent analgesic and antiemetic. However, the benefit of dexamethasone after TKA is unclear, as is the efficacy in a current multimodal regime.

Questions/purposes

We determined (1) whether the addition of dexamethasone to a protocol including ramosetron further reduces postoperative emesis compared with ramosetron alone; (2) whether it reduces postoperative pain; and (3) whether it increases the risk for wound complications in a current multimodal regime after TKA.

Methods

We randomized 269 patients undergoing TKAs to receive dexamethasone (10 mg) 1 hour before surgery and ramosetron immediately after surgery (Dexa-Ra group, n = 135), or ramosetron alone (Ra group, n = 134). We recorded the incidence of postoperative nausea and vomiting (PONV), severity of nausea, incidence of antiemetic requirement, complete response, pain level, and opioid consumption. Patients were assessed 0 to 6, 6 to 24, 24 to 48, and 48 to 72 hours postoperatively. In addition, patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery.

Results

The Dexa-Ra group had a lower incidence of PONV during the entire 72-hour evaluation period and experienced less severe nausea for the first 6 hours after TKA, although not between 6 to 72 hours. Overall use of a rescue antiemetic was less frequent, and complete response was more frequent in the Dexa-Ra group. Patients in the Dexa-Ra group experienced lower pain and consumed less opioids during the 6- to 24-hour period and during the overall study period. No differences were found in wound complications between the groups, and each group had one case of periprosthetic joint infection.

Conclusions

Patients who received prophylactic dexamethasone in addition to ramosetron had reduced postoperative emesis and pain without increased risks for wound complications, compared with patients who received ramosetron alone in patients managed using a multimodal regimen after TKA.

Level of Evidence

Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • In Jun Koh
    • 1
    • 2
  • Chong Bum Chang
    • 3
    • 4
  • Jung Ha Lee
    • 3
  • Young-Tae Jeon
    • 5
  • Tae Kyun Kim
    • 3
    • 4
  1. 1.Department of Orthopaedic SurgeryUijeongbu St. Mary’s HospitalUijeongbu-siKorea
  2. 2.Department of Orthopaedic SurgeryCatholic University of Korea College of MedicineSeoulKorea
  3. 3.Joint Reconstruction CenterSeoul National University Bundang HospitalSeongnam-siKorea
  4. 4.Department of Orthopaedic SurgerySeoul National University College of MedicineSeoulKorea
  5. 5.Department of Anesthesiology and Pain MedicineSeoul National University Bundang, HospitalSeongnamKorea