Abstract
Introduction
This study aims to investigate the effect of pre-operative intravenous methylprednisolone on post-operative pain control and joint mobility in Chinese patients undergoing single primary total knee arthroplasty.
Methods
This is a prospective, randomized, double-blinded, placebo-controlled single-centre trial. Sixty subjects were randomized into intervention and control group. The peri-operative anaesthetic and analgesic regimes were standardized. The intervention group received 125 mg methylprednisolone intravenously on the induction of anaesthesia. Subjects were assessed at 24, 30 and 48 h after surgery and upon discharge for pain scores and range of movement from the operated knee. Change in C-reactive protein level was calculated. Patient’s satisfaction was recorded. Adverse reactions were documented. Subjects were followed up at 6 weeks, 4 months and 1 year.
Results
Rest pain and pain on movement were significantly reduced in the methylprednisolone group at 24 and 30 h after surgery (ANOVA p = 0.030, p = 0.003, p = 0.032, p = 0.010). The methylprednisolone group demonstrated a greater range of movement from the operated knee up to 30 h after surgery (ANOVA p = 0.031). Post-operative C-reactive protein level was significantly less in the methylprednisolone group (p < 0.001). Methylprednisolone group had a higher patient’s satisfaction than the control group (p < 0.01). No adverse effects were noted at the 1-year follow-up.
Conclusion
Pre-operative intravenous methylprednisolone improves post-operative pain and joint mobility after total knee arthroplasty up to 30 h after operation. It results in a higher patients’ satisfaction. It can act as an effective adjunct in the multimodal analgesic regime.
Trial registration
ClinicalTrials.gov ID: NCT03082092.
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References
Skou ST, Roos EM, Laursen MB et al (2015) A randomized, controlled trial of total knee replacement. N Engl J Med 373(17):1597–1606
Gunaratne R, Pratt DN, Banda J et al (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 32(12):3854–3860
Myles PS, Williams DL, Hendrata M et al (2000) Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth 84(1):6–10
Jules- Elysee KM, Wilfred SE, Memtsoudis SG et al (2012) Steroid modulation of cytokine release and desmosine levels in bilateral total knee replacement: a prospective, double-blind, randomized controlled trial. J Bone Joint Surg Am 94(23):2120–2127
Lunn TH, Kristensen BB, Andersen LO et al (2011) Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial. Br J Anaesth 106(2):230–238
Karst M, Kegel T, Lukas A et al (2003) Effect of celecoxib and dexamethasone on postoperative pain after lumbar disc surgery. Neurosurgery 53(2):331–336 (discussion 36–37)
Aminmansour B, Khalili HA, Ahmadi J et al (2006) Effect of high-dose intravenous dexamethasone on postlumbar discectomy pain. Spine (Phila Pa 1976) 31(21):2415–2417
Romundstad L, Breivik H, Roald H et al (2006) Methylprednisolone reduces pain, emesis, and fatigue after breast augmentation surgery: a single-dose, randomized, parallel-group study with methylprednisolone 125 mg, parecoxib 40 mg, and placebo. Anesth Analg 102(2):418–425
Bisgaard T, Klarskov B, Kehlet H et al (2003) Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial. Ann Surg 238(5):651–660
Kardash KJ, Sarrazin F, Tessler MJ et al (2008) Single-dose dexamethasone reduces dynamic pain after total hip arthroplasty. Anesth Analg 106(4):1253–1257 (table of contents)
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(1):100
Meng J, Li L (2017) The efficiency and safety of dexamethasone for pain control in total joint arthroplasty: a meta-analysis of randomized controlled trials. Medicine (Baltimore) 96(24):e7126
Hartman J, Khanna V, Habib A et al (2017) Perioperative systemic glucocorticoids in total hip and knee arthroplasty: a systematic review of outcomes. J Orthop 14(2):294–301
Xing LZ, Li L, Zhang LJ (2017) Can intravenous steroid administration reduce postoperative pain scores following total knee arthroplasty? A meta-analysis. Medicine (Baltimore) 96(24):e7134
Liu G, Gong M, Wang Y et al (2018) Effect of methylprednisolone on pain management in total knee or hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Clin J Pain 34(10):967–974
De Oliveira GS Jr, Almeida MD, Benzon HT et al (2011) Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 115(3):575–588
Backes JR, Bentley JC, Politi JR et al (2013) Dexamethasone reduces length of hospitalization and improves postoperative pain and nausea after total joint arthroplasty: a prospective, randomized controlled trial. J Arthroplasty 28(8 Suppl):11–17
Koh IJ, Chang CB, Lee JH et al (2013) Preemptive low-dose dexamethasone reduces postoperative emesis and pain after TKA: a randomized controlled study. Clin Orthop Relat Res 471(9):3010–3020
Jules-Elysee KM, Lipnitsky JY, Patel N et al (2011) Use of low-dose steroids in decreasing cytokine release during bilateral total knee replacement. Reg Anesth Pain Med 36(1):36–40
Meikle AW, Tyler FH (1977) Potency and duration of action of glucocorticoids. Effects of hydrocortisone, prednisone and dexamethasone on human pituitary-adrenal function. Am J Med 63(2):200–207
Sauerland S, Nagelschmidt M, Mallmann P et al (2000) Risks and benefits of preoperative high dose methylprednisolone in surgical patients: a systematic review. Drug Saf 23(5):449–461
Henzi I, Walder B, Tramer MR (2000) Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 90(1):186–194
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Prior approval from institutional review board was obtained (Research Ethics Committee, Ref: KC/KE-17-0032/FR-4).
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Informed consent was obtained from all individual participants included in the study.
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Cheng, B.L.Y., So, E.H.K., Hui, G.K.M. et al. Pre-operative intravenous steroid improves pain and joint mobility after total knee arthroplasty in Chinese population: a double-blind randomized controlled trial. Eur J Orthop Surg Traumatol 29, 1473–1479 (2019). https://doi.org/10.1007/s00590-019-02469-5
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DOI: https://doi.org/10.1007/s00590-019-02469-5