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The application of low-dose dexamethasone in total knee arthroplasty: finding out the best route and dosage schedule

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

The use of dexamethasone as additive to multimodal analgesic regimen in total knee arthroplasty has been well established, but the most suitable route, effectiveness, safety and dose schedule of low-dose dexamethasone is not known.

Methods

We conducted a prospective, randomized, double-blinded trial to investigate and compare the analgesic and antiemetic effects and safety of low-dose (8 mg) dexamethasone introduced as periarticular injection or intravenous (as a single dose or in two divided doses of 4 mg separated by 24 h) in unilateral total knee arthroplasty patients.

Results

The single dose intravenous administration as well as the periarticular administration of dexamethasone had similar mean visual analogue scores which were significantly lower than divided dose group at 24 and 48 h postoperatively. The rate of postoperative nausea and vomiting was lowest among single intravenous dose group and highest among interval dose group at 24 h, while no difference was noted at 48 h. No significant differences were noted in terms of knee flexion angle at 48 h and modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 6 weeks.

Conclusion

Single low-dose intravenous dexamethasone is the most appropriate dose which can safely be given to TKA patients and is only moderately associated with rise in blood sugar not causing any significant complication. Alternatively, periarticular infiltration of low-dose dexamethasone can produce equivalent analgesic effect as SDIV in first 24 h without causing significant blood sugar rise and wound complications, but its antiemetic effect remains subtle. Therefore, it is recommended to further study the combination of intraoperative periarticular and postoperative intravenous dexamethasone for their possible additive effect.

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Funding

No funding was received for conducting this study. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. FNB (Arthroplasty) Trainee, Arthroplasty division, Star Hospitals, Hyderabad, India

    Mukesh Kumar Saini & Challa Dinesh Reddy

  2. Consultant, Department of Orthopaedics, Arthroplasty Division, Star Hospitals, B Block Road no 10 Banjara Hills, Hyderabad, India

    Neelam Ramana Reddy & Ajay Singh Thakur

  3. Senior resident, Department of Orthopaedics, Star Hospitals, B Block Road no 10 Banjara Hills, Hyderabad, India

    Pera Jayavardhan Reddy

Authors
  1. Mukesh Kumar Saini
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  2. Neelam Ramana Reddy
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  3. Pera Jayavardhan Reddy
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  4. Ajay Singh Thakur
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  5. Challa Dinesh Reddy
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Contributions

Neelam Ramana Reddy was the guarantor and designed the study; Mukesh Kumar Saini participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Pera Jayavardhan Reddy, Ajay Singh Thakur, and Challa Dinesh Reddy revised the article critically for important intellectual content.

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Correspondence to Mukesh Kumar Saini.

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Saini, M.K., Reddy, N.R., Reddy, P.J. et al. The application of low-dose dexamethasone in total knee arthroplasty: finding out the best route and dosage schedule. Arch Orthop Trauma Surg 143, 1005–1012 (2023). https://doi.org/10.1007/s00402-022-04356-x

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  • DOI: https://doi.org/10.1007/s00402-022-04356-x

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