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The efficacy and safety of two low-dose peri-operative dexamethasone on pain and recovery following total hip arthroplasty: a randomized controlled trial

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Abstract

Purpose

To evalute the efficacy and safety of two low-dose peri-operative dexamethasone on pain and recovery following total hip arthroplasty (THA).

Methods

One hundred ten patients received two-dose of 10 mg IV-dexamethasone (group dexa) or IV-isotonic saline (group placebo). The level of C-reactive protein (CRP) and interleukin-6 (IL-6), pain at rest and during mobilization, incidence of post-operative nausea and vomiting (PONV), intensity of nausea, post-operative fatigue, consumption of analgesic and antiemetic rescue, range of motion (ROM), post-operative length of stay (post-operative LOS), wound problems and complications were recorded and compared.

Results

The level of inflammation markers (CRP, IL-6) in group dexa was lower than group placebo at 24, 48, 72 hours post-operatively. Dynamic pain VAS score at 24 hours was lower in group dexa (P = 0.002), however, there was no significant effect on pain at rest. In group dexa, patients had a lower incidence of PONV (P = 0.003), as well as a lower VAS score of nausea (P = 0.044). The post-operative fatigue (P < 0.001) was relieved and the consumption of analgesic and antiemetic rescues were reduced. Furthermore, patients had better maximum hip flexion (P < 0.001) and abduction (P = 0.017), with shorter post-operative LOS (P = 0.006). There is no difference between groups in wound problems. No surgical site infection or gastrointestinal haemorrhage was detected in both groups.

Conclusions

The administration of two low-dose peri-operative dexamethasone can effectively reduce the post-operative level of CRP and IL-6, provide additional pain and nausea control, ameliorate post-operative fatigue, enhance mobility, and shorten post-operative LOS following THA, without increasing the risk of infection and gastrointestinal hemorrhage.

Level of evidence: I

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Author notes

  1. Lei and Xu contributed equally to this work and should be considered as equal first authors.

Authors and Affiliations

  1. Department of Orthopaedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People’s Republic of China

    Yi-ting Lei, Bin Xu, Xiao-wei Xie, Jin-wei Xie, Qiang Huang & Fu-xing Pei

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  1. Yi-ting Lei
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  2. Bin Xu
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  3. Xiao-wei Xie
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  4. Jin-wei Xie
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  6. Fu-xing Pei
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Corresponding author

Correspondence to Fu-xing Pei.

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Conflict of interest

All authors declare no conflict of interest.

Funding

This study was funded by the National Health and Family Planning Commission of the People’s Republic of China (CN) program (201302007).

Ethical approval

The trial was approved by the institutional review board and registered in the International Clinical Trial Registry (ChiCTR-IOR-16008865).

Informed consent

Informed consent was obtained from all participants included in the study.

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Lei, Yt., Xu, B., Xie, Xw. et al. The efficacy and safety of two low-dose peri-operative dexamethasone on pain and recovery following total hip arthroplasty: a randomized controlled trial. International Orthopaedics (SICOT) 42, 499–505 (2018). https://doi.org/10.1007/s00264-017-3537-8

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  • DOI: https://doi.org/10.1007/s00264-017-3537-8

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