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Increased postoperative dexamethasone and gabapentin reduces opioid consumption after total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope



Dexamethasone and gabapentin are used in multimodal pain management protocols to reduce postoperative pain after total knee arthroplasty. For both analgesic adjuvants, the optimal dose regimen to reduce opioid usage is still unclear.


The opioid consumption of patients undergoing primary TKA before and after a change of the analgesic adjuvant medication in our protocol (old protocol: 4 mg of dexamethasone daily for 2 days, 600 mg gabapentin daily for 1 week; new protocol: 10 mg dexamethasone daily for 2 days, 300 mg gabapentin every 8 h for 1 week) were retrospectively compared. All surgeries were performed under spinal anesthesia. Peri- and postoperative pain medication remained unchanged.


A total of 186 patients who received TKA between 11/29/2016 and 06/09/2017 were screened. Six patients who received general anesthesia, 4 patients who underwent simultaneous bilateral TKA, and 16 patients with ongoing opioid consumption at the time of surgery were excluded, leaving 80 patients in each group. Opioid consumption within 24 h [morphine equivalents in mg: mean 50.5, standard deviation (SD) 30.0 (old) vs. 39.8, SD 24.2 (new); P = 0.0470], cumulative consumption over 48 h (97.3, SD 64.4 vs. 70.4, SD 51.2; P = 0.0040) and cumulative consumption over 72 h (108.1, SD 79.5 vs. 82.5, SD 72.6; P = 0.0080), were all significantly lower in the new protocol.


Increased postoperative administration of dexamethasone and gabapentin after TKA is associated with lower opioid consumption. Within the first 48 h, up to about 25% of opioids can be spared, comparing high-dose to low-dose protocols.

Level of evidence

Therapeutic Level III.

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Body mass index


Date of surgery


Patient-controlled anesthesia


Postoperative nausea and vomiting


Persistent post-surgical pain


Standard deviation


Total knee arthroplasty


Treated per protocol


  1. Gerbershagen HJ, Aduckathil S, van Wijck AJM, Peelen LM, Kalkman CJ, Meissner W (2013) Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 118:934–944

    Article  PubMed  Google Scholar 

  2. Kehlet H, Jensen TS, Woolf CJ (2006) Persistent postsurgical pain: risk factors and prevention. Lancet 367:1618–1625

    Article  PubMed  Google Scholar 

  3. Grosu I, Lavand’homme P, Thienpont E (2014) Pain after knee arthroplasty: an unresolved issue. Knee Surg Sport Traumatol Arthrosc 22:1744–1758

    Article  Google Scholar 

  4. Turan A, Sessler DI (2011) Steroids to ameliorate postoperative pain. Anesthesiology 115:457–459

    Article  PubMed  Google Scholar 

  5. Liu X, Liu J, Sun G (2017) Preoperative intravenous glucocorticoids can reduce postoperative acute pain following total knee arthroplasty. Medicine 96:e7836. (Baltimore)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Lunn TH, Kehlet H (2013) Perioperative glucocorticoids in hip and knee surgery—benefit vs. harm? A review of randomized clinical trials. Acta Anaesthesiol Scand 57:823–834

    Article  CAS  PubMed  Google Scholar 

  7. Yue C, Wei R, Liu Y (2017) Perioperative systemic steroid for rapid recovery in total knee and hip arthroplasty: a systematic review and meta-analysis of randomized trials. J Orthop Surg Res 12:100

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gilron I (2007) Gabapentin and pregabalin for chronic neuropathic and early postsurgical pain: current evidence and future directions. Curr Opin Anaesthesiol 20:456–472

    Article  PubMed  Google Scholar 

  9. Ho K-Y, Gan TJ, Habib AS (2006) Gabapentin and postoperative pain—a systematic review of randomized controlled trials. Pain 126:91–101

    Article  CAS  PubMed  Google Scholar 

  10. Zhai L, Song Z, Liu K (2016) The effect of gabapentin on acute postoperative pain in patients undergoing total knee arthroplasty. Medicine 95:e3673. (Baltimore)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Clarke H, Pereira S, Kennedy D, Gilron I, Katz J, Gollish J, Kay J (2009) Gabapentin decreases morphine consumption and improves functional recovery following total knee arthroplasty. Pain Res Manag 14:217–222

    Article  PubMed  PubMed Central  Google Scholar 

  12. Jules-Elysee KM, Wilfred SE, Memtsoudis SG, Kim DH, YaDeau JT, Urban MK, Lichardi ML, McLawhorn AS, Sculco TP (2012) Steroid modulation of cytokine release and desmosine levels in bilateral total knee replacement: a prospective, double-blind, randomized controlled trial. J Bone Jt Surg Am 94:2120–2127

    Article  Google Scholar 

  13. National Center for Injury Prevention and Control (2018) CDC compilation of benzodiazepines, muscle relaxants, stimulants, zolpidem, and opioid analgesics with oral morphine milligram equivalent conversion factors, 2018 version. Atlanta, GA, USA

  14. Han C, Li X-D, Jiang H-Q, Ma J-X, Ma X-L (2016) The use of gabapentin in the management of postoperative pain after total hip arthroplasty: a meta-analysis of randomised controlled trials. J Orthop Surg Res BioMed Central 11:79

    Article  Google Scholar 

  15. Han C, Li X, Jiang H, Ma J, Ma X (2016) The use of gabapentin in the management of postoperative pain after total knee arthroplasty. Medicine 95:e3883. (Baltimore)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Pandey CK, Navkar DV, Giri PJ, Raza M, Behari S, Singh RB, Singh U, Singh PK (2005) Evaluation of the optimal preemptive dose of gabapentin for postoperative pain relief after lumbar diskectomy: a randomized, double-blind, placebo-controlled study. J Neurosurg Anesthesiol 17:65–68

    Article  PubMed  Google Scholar 

  17. Fan Z, Ma J, Kuang M, Zhang L, Han B, Yang B, Wang Y, Ma X (2018) The efficacy of dexamethasone reducing postoperative pain and emesis after total knee arthroplasty: a systematic review and meta-analysis. Int J Surg 52:149–155

    Article  PubMed  Google Scholar 

  18. Li X, Xu G, Xie W, Ma S (2018) The efficacy and safety of dexamethasone for pain management after total knee arthroplasty: a systematic review and meta-analysis. Int J Surg 53:65–71

    Article  PubMed  Google Scholar 

  19. Mohammad HR, Hamilton TW, Strickland L, Trivella M, Murray D, Pandit H (2018) Perioperative adjuvant corticosteroids for postoperative analgesia in knee arthroplasty. Acta Orthop 89:71–76

    Article  PubMed  Google Scholar 

  20. De Oliveira GS, Almeida MD, Benzon HT, McCarthy RJ (2011) Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 115:575–588

    Article  CAS  PubMed  Google Scholar 

  21. Jørgensen CC, Pitter FT, Kehlet H, Lundbeck Foundation Center for Fast-track Hip and Knee Replacement Collaborative Group (2017) Safety aspects of preoperative high-dose glucocorticoid in primary total knee replacement. Br J Anaesth 119:267–275

    Article  PubMed  Google Scholar 

  22. Jules-Elysee KM, Lipnitsky JY, Patel N, Anastasian G, Wilfred SE, Urban MK, Sculco TP (2011) Use of low-dose steroids in decreasing cytokine release during bilateral total knee replacement. Reg Anesth Pain Med 36:36–40

    Article  CAS  PubMed  Google Scholar 

  23. Baird CRW, Fox P, Colvin LA (2014) Gabapentinoid abuse in order to potentiate the effect of methadone: a survey among substance misusers. Eur Addict Res 20:115–118

    Article  PubMed  Google Scholar 

  24. Zacny JP, Paice JA, Coalson DW (2012) Subjective, psychomotor, and physiological effects of pregabalin alone and in combination with oxycodone in healthy volunteers. Pharmacol Biochem Behav 100:560–565

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations



LE participated in the design of the study, carried out data abstraction and drafted the manuscript. TJ participated in the design of the study, carried out data abstraction and helped to draft the manuscript. JEC and SS performed the statistical analysis. WF conceived the study and participated in its design and coordination, and helped to draft the manuscript. All authors read and approved the final manuscript.

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Correspondence to Lukas Eckhard.

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The authors declare that they have no conflict of interest.

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The study was conducted after approval from the IRB at Brigham and Women’s Hospital.

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Eckhard, L., Jones, T., Collins, J.E. et al. Increased postoperative dexamethasone and gabapentin reduces opioid consumption after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27, 2167–2172 (2019).

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