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Two doses of low-dose perioperative dexamethasone improve the clinical outcome after total knee arthroplasty: a randomized controlled study

Knee Surgery, Sports Traumatology, Arthroscopy volume 26, pages 1549–1556 (2018)Cite this article

An Erratum to this article was published on 19 June 2017

This article has been updated

Abstract

Purpose

To study the clinical effect and safety of two doses of low-dose perioperative dexamethasone on pain and recovery after total knee arthroplasty.

Methods A total of 108 patients were included in this randomized, double-blinded, placebo-controlled study. They received two doses of 10 mg IV dexamethasone (group Dexa) or IV isotonic saline (group Placebo). The CRP, IL-6 and pain levels, postoperative nausea and vomiting (PONV) incidence, nausea severity, postoperative fatigue, range of motion, length of stay, analgesic rescue and antiemetic rescue consumption, and complications were compared.

Results The CRP and IL-6 levels in group Dexa were lower than in group Placebo at 24, 48, and 72 h postoperatively (P < 0.001, P < 0.001, and P < 0.001, respectively). In group Dexa, patients had less pain at 24 h postoperatively, at rest (P < 0.001) and during walking (P < 0.001); they also had a lower PONV incidence (P = 0.002) and a lower nausea VAS score (P = 0.008). Postoperative fatigue (P < 0.001) was relieved and the analgesic and antiemetic rescue consumption was reduced. Length of stay (n.s.) and range of motion (n.s.) were similar in both groups. No early surgical wound infection or gastrointestinal haemorrhage occurred in either group.

Conclusions Administering two doses of low-dose perioperative dexamethasone for patients receiving total knee arthroplasty reduces postoperative CRP and IL-6 levels, provides additional analgesic effect, and reduces the PONV incidence and postoperative fatigue, without increasing the risk of early surgical wound infection and gastrointestinal haemorrhage. So two doses of low-dose perioperative dexamethasone are effective and safe for patients receiving TKA to decrease the inflammatory response, prevent PONV, relieve postoperative pain and fatigue, and enhance recovery.

Level of evidence I.

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Change history

  • 19 June 2017

    An erratum to this article has been published.

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Acknowledgements

The study was supported by Ministry of Health of the People’s Republic of China (201302007).

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    Affiliations

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

      Bin Xu, Jun Ma, Qiang Huang, Ze-yu Huang, Shao-yun Zhang & Fu-xing Pei

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    1. Bin Xu
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    2. Jun Ma
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    3. Qiang Huang
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    4. Ze-yu Huang
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    5. Shao-yun Zhang
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    Corresponding author

    Correspondence to Fu-xing Pei.

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    Conflict of interest

    All authors declare that they have no conflict of interest.

    Ethical approval

    The study protocol was approved by the Institutional Review Board of West China Medical Center of Sichuan University (No. 201302007) before patient enrolment.

    Funding

    This study was funded by Ministry of Health of the People’s Republic of China (no. 201302007).

    Informed consent

    Written informed consent and research authorization were obtained from all patients.

    Additional information

    The original version of this article was revised: Unfortunately, the online published article has error in Table 2. In the Metoclopramide, Number of patients requiring, The P value should be 0.018.

    Xu and Ma have contributed equally to this study.

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    Cite this article

    Xu, B., Ma, J., Huang, Q. et al. Two doses of low-dose perioperative dexamethasone improve the clinical outcome after total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 26, 1549–1556 (2018). https://doi.org/10.1007/s00167-017-4506-x

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    • DOI: https://doi.org/10.1007/s00167-017-4506-x

    Keywords

    • Dexamethasone
    • Total knee arthroplasty
    • Clinical effect
    • Randomized controlled study