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Effects of combined dexamethasone and tranexamic acid in lower limb total arthroplasty: a systematic review and meta-analysis of randomized clinical trials

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Abstract

Purpose

To evaluate the effectiveness of combined Tranexamic acid (TXA) and dexamethasone (DEX) in total hip and knee arthroplasty.

Methods

PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched for randomized studies that utilized TXA and DEX administration of TXA in THA or TKA.

Results

A total of three randomized studies enrolling 288 patients were eligible for qualitative and quantitative analysis. DEX + TXA group demonstrated statistical significantly lesser usage of oxycodone (OR: 0.34, p < 0.0001), metoclopramide (OR: 0.21, p < 0.00001), lesser incidence of postoperative nausea and vomiting (OR: 0.27, p < 0.0001), better postoperative range of motion (MD: 2.30, p < 0.00001) and shorter length of hospital stay (MD: 0.31, p = 0.03). Comparable results were seen in total blood loss, transfusion rate and postoperative complications.

Conclusion

In this meta-analysis, the combination of TXA and DEX has positive impacts on the usage of oxycodone and metoclopramide, postoperative range of motion, postoperative nausea and vomiting and reduces the length of hospital stay.

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Abbreviations

ASA:

American Society of Anaesthesia

BMI:

Body Mass Index

CI:

Confidence interval

DF:

Degree of freedom

I 2 :

Heterogeneity

IV:

Intravenous

NA:

Not applicable

NR:

Not reported

SD:

Standard deviation

SE:

Standard error

DEX:

Dexamethasone

TXA:

Tranexamic acid group

THA:

Total hip arthroplasty

TKA:

Total knee arthroplasty

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Acknowledgements

The authors would like to express their gratitude to the team for their significant efforts.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Monash Health Dandenong Hospital, Dandenong, VIC, Australia

    Tze Khiang Tan

  2. Royal Perth Hospital, Perth, WA, Australia

    Arjun Gopal Subramaniam

  3. Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia

    Raphael Hau

  4. Department of Surgery, University of Melbourne, Carlton, VIC, Australia

    Raphael Hau

Authors
  1. Tze Khiang Tan
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  2. Arjun Gopal Subramaniam
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  3. Raphael Hau
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Correspondence to Tze Khiang Tan.

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Tan, T.K., Gopal Subramaniam, A. & Hau, R. Effects of combined dexamethasone and tranexamic acid in lower limb total arthroplasty: a systematic review and meta-analysis of randomized clinical trials. Eur J Orthop Surg Traumatol 33, 3327–3335 (2023). https://doi.org/10.1007/s00590-023-03612-z

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  • DOI: https://doi.org/10.1007/s00590-023-03612-z

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