Skip to main content
SpringerLink
Log in

Two doses of low-dose perioperative dexamethasone improve the clinical outcome after total knee arthroplasty: a randomized controlled study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

An Erratum to this article was published on 19 June 2017

This article has been updated

Abstract

Purpose

To study the clinical effect and safety of two doses of low-dose perioperative dexamethasone on pain and recovery after total knee arthroplasty.

Methods A total of 108 patients were included in this randomized, double-blinded, placebo-controlled study. They received two doses of 10 mg IV dexamethasone (group Dexa) or IV isotonic saline (group Placebo). The CRP, IL-6 and pain levels, postoperative nausea and vomiting (PONV) incidence, nausea severity, postoperative fatigue, range of motion, length of stay, analgesic rescue and antiemetic rescue consumption, and complications were compared.

Results The CRP and IL-6 levels in group Dexa were lower than in group Placebo at 24, 48, and 72 h postoperatively (P < 0.001, P < 0.001, and P < 0.001, respectively). In group Dexa, patients had less pain at 24 h postoperatively, at rest (P < 0.001) and during walking (P < 0.001); they also had a lower PONV incidence (P = 0.002) and a lower nausea VAS score (P = 0.008). Postoperative fatigue (P < 0.001) was relieved and the analgesic and antiemetic rescue consumption was reduced. Length of stay (n.s.) and range of motion (n.s.) were similar in both groups. No early surgical wound infection or gastrointestinal haemorrhage occurred in either group.

Conclusions Administering two doses of low-dose perioperative dexamethasone for patients receiving total knee arthroplasty reduces postoperative CRP and IL-6 levels, provides additional analgesic effect, and reduces the PONV incidence and postoperative fatigue, without increasing the risk of early surgical wound infection and gastrointestinal haemorrhage. So two doses of low-dose perioperative dexamethasone are effective and safe for patients receiving TKA to decrease the inflammatory response, prevent PONV, relieve postoperative pain and fatigue, and enhance recovery.

Level of evidence I.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Change history

  • 19 June 2017

    An erratum to this article has been published.

References

  1. Backes JR, Bentley JC, Politi JR, Chambers BT (2013) Dexamethasone reduces length of hospitalization and improves postoperative pain and nausea after total joint arthroplasty: a prospective, randomized controlled trial. J Arthroplast 28(8 Suppl):11–17

    Article  Google Scholar 

  2. Bautmans I, Njemini R, De Backer J, De Waele E, Mets T (2010) Surgery-induced inflammation in relation to age, muscle endurance, and self-perceived fatigue. J Gerontol A Biol Sci Med Sci 65(3):266–273

    Article  CAS  PubMed  Google Scholar 

  3. Bautmans I, Njemini R, Lambert M, Demanet C, Mets T (2005) Circulating acute phase mediators and skeletal muscle performance in hospitalized geriatric patients. J Gerontol A Biol Sci Med Sci 60(3):361–367

    Article  PubMed  Google Scholar 

  4. Bird SB, Dickson EW (2001) Clinically significant changes in pain along the visual analog scale. Ann Emerg Med 38(6):639–643

    Article  CAS  PubMed  Google Scholar 

  5. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J (2003) Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial. Ann Surg 238(5):651–660

    Article  PubMed  PubMed Central  Google Scholar 

  6. De Oliveira GS Jr, Almeida MD, Benzon HT, McCarthy RJ (2011) Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 115(3):575–588

    Article  PubMed  Google Scholar 

  7. Fujii Y, Nakayama M (2005) Effects of dexamethasone in preventing postoperative emetic symptoms after total knee replacement surgery: a prospective, randomized, double-blind, vehicle-controlled trial in adult Japanese patients. Clin Ther 27(6):740–745

    Article  CAS  PubMed  Google Scholar 

  8. Gilron I (2004) Corticosteroids in postoperative pain management: future research directions for a multifaceted therapy. Acta Anaesthesiol Scand 48(10):1221–1222

    Article  CAS  PubMed  Google Scholar 

  9. Holte K, Kehlet H (2002) Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg 195(5):694–712

    Article  PubMed  Google Scholar 

  10. Husted H, Jensen CM, Solgaard S, Kehlet H (2012) Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: from research to implementation. Arch Orthop Trauma Surg 132(1):101–104

    Article  PubMed  Google Scholar 

  11. Jensen MP, Chen C, Brugger AM (2003) Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 4(7):407–414

    Article  PubMed  Google Scholar 

  12. 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

    Article  CAS  PubMed  Google Scholar 

  13. Kehlet H, Jensen TS, Woolf CJ (2006) Persistent postsurgical pain: risk factors and prevention. The Lancet 367(9522):1618–1625

    Article  Google Scholar 

  14. Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183(6):630–641

    Article  PubMed  Google Scholar 

  15. Koh IJ, Chang CB, Lee JH, Jeon YT, Kim TK (2013) Preemptive low-dose dexamethasone reduces postoperative emesis and pain after TKA: a randomized controlled study. Clin Orthop Relat Res 471(9):3010–3020

    Article  PubMed  PubMed Central  Google Scholar 

  16. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  PubMed  PubMed Central  Google Scholar 

  17. 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(7):823–834

    Article  CAS  PubMed  Google Scholar 

  18. 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

    Article  CAS  PubMed  Google Scholar 

  19. Miyagawa Y, Ejiri M, Kuzuya T, Osada T, Ishiguro N, Yamada K (2010) Methylprednisolone reduces postoperative nausea in total knee and hip arthroplasty. J Clin Pharm Ther 35(6):679–684

    Article  CAS  PubMed  Google Scholar 

  20. Paddison JS, Booth RJ, Fuchs D, Hill AG (2008) Peritoneal inflammation and fatigue experiences following colorectal surgery: a pilot study. Psychoneuroendocrinology 33(4):446–454

    Article  PubMed  Google Scholar 

  21. Paddison JS, Booth RJ, Hill AG, Cameron LD (2006) Comprehensive assessment of peri-operative fatigue: development of the Identity-Consequence Fatigue Scale. J Psychosom Res 60(6):615–622

    Article  PubMed  Google Scholar 

  22. 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

    Article  CAS  PubMed  Google Scholar 

  23. Salerno A, Hermann R (2006) Efficacy and safety of steroid use for postoperative pain relief. Update and review of the medical literature. J Bone Joint Surg Am 88(6):1361–1372

    Article  PubMed  Google Scholar 

  24. Sean VW, Chin PL, Chia SL, Yang KY, Lo NN, Yeo SJ (2011) Single-dose periarticular steroid infiltration for pain management in total knee arthroplasty: a prospective, double-blind, randomised controlled trial. Singapore Med J 52(1):19–23

    CAS  PubMed  Google Scholar 

  25. Wehner S, Vilz TO, Stoffels B, Kalff JC (2012) Immune mediators of postoperative ileus. Langenbecks Arch Surg 397(4):591–601

    Article  PubMed  Google Scholar 

  26. Wilmore DW, Kehlet H (2001) Management of patients in fast track surgery. BMJ 322(7284):473–476

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Xie J, Ma J, Yao H, Yue C, Pei F (2016) Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss After primary total knee arthroplasty without tourniquet: a randomized clinical trial. J Arthroplast 31(11):2458–2464

    Article  Google Scholar 

  28. Zargar-Shoshtari K, Paddison JS, Booth RJ, Hill AG (2009) A prospective study on the influence of a fast-track program on postoperative fatigue and functional recovery after major colonic surgery. J Surg Res 154(2):330–335

    Article  PubMed  Google Scholar 

  29. Zhang JM, An J (2007) Cytokines, inflammation, and pain. Int Anesthesiol Clin 45(2):27–37

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The study was supported by Ministry of Health of the People’s Republic of China (201302007).

Author information

Author notes

    Authors and Affiliations

    1. Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People’s Republic of China

      Bin Xu, Jun Ma, Qiang Huang, Ze-yu Huang, Shao-yun Zhang & Fu-xing Pei

    Authors
    1. Bin Xu
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Jun Ma
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Qiang Huang
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Ze-yu Huang
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Shao-yun Zhang
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Fu-xing Pei
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Fu-xing Pei.

    Ethics declarations

    Conflict of interest

    All authors declare that they have no conflict of interest.

    Ethical approval

    The study protocol was approved by the Institutional Review Board of West China Medical Center of Sichuan University (No. 201302007) before patient enrolment.

    Funding

    This study was funded by Ministry of Health of the People’s Republic of China (no. 201302007).

    Informed consent

    Written informed consent and research authorization were obtained from all patients.

    Additional information

    The original version of this article was revised: Unfortunately, the online published article has error in Table 2. In the Metoclopramide, Number of patients requiring, The P value should be 0.018.

    Xu and Ma have contributed equally to this study.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Xu, B., Ma, J., Huang, Q. et al. Two doses of low-dose perioperative dexamethasone improve the clinical outcome after total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 26, 1549–1556 (2018). https://doi.org/10.1007/s00167-017-4506-x

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00167-017-4506-x

    Keywords

    Search

    Navigation