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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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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Abbreviations

BMI:

Body mass index

DOS:

Date of surgery

PCA:

Patient-controlled anesthesia

PONV:

Postoperative nausea and vomiting

PPSP:

Persistent post-surgical pain

SD:

Standard deviation

TKA:

Total knee arthroplasty

TPP:

Treated per protocol

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Funding

There was no external funding provided for the study.

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Authors

Contributions

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.

Corresponding author

Correspondence to Lukas Eckhard.

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The authors declare that they have no conflict of interest.

Ethical approval

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). https://doi.org/10.1007/s00167-019-05449-8

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Keywords

  • TKA
  • Pain
  • Opioids
  • Glucocorticoids
  • Gabapentin