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Dose optimization of intravenous dexamethasone for total knee arthroplasty: when two is not better than one

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

Abstract

Background

The optimal dose regimen of dexamethasone in total knee arthroplasty (TKA) has not been determined. This study was performed to evaluate the impact of a single preoperative high-dose dexamethasone compared with two perioperative low-dose dexamethasone in TKA.

Materials and methods

We prospectively studied three regimens on dexamethasone: no dexamethasone (A), a single preoperative dose of 20-mg dexamethasone (B), and two perioperative doses of 10-mg dexamethasone (C). The primary outcome was postoperative pain level. The incidence of postoperative nausea and vomiting (PONV), use of analgesic and antiemetic rescue, interleukin-6 (IL-6) and C-reactive protein (CRP) levels, range of motion (ROM), and complications were also compared.

Results

The dynamic pain scores and CRP and IL-6 levels were significantly lower for Group B compared to Groups A and C on postoperative days 1 and 2 (POD 1 and 2). Such differences were also detected between Groups C and A. Besides, the pain scores at rest were significantly lower in Groups B and C than in Group A on POD 1 and 2. Patients in Groups B and C had a lower incidence of PONV, reduced use of analgesic and antiemetic rescue, and improved ROM than in Group A. No complications occurred in any group.

Conclusion

Dexamethasone in TKA provides short-term advantages in analgesic, antiemetic and anti-inflammatory effects. Besides, regarding the effects of pain and inflammatory control on POD 1 and 2, a single preoperative high dose of 20-mg dexamethasone was more effective than two perioperative low doses of 10-mg dexamethasone.

Level of evidence

I.

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Funding

This study was funded by the National Health and Family Planning Commission of the People's Republic of China (CN) program (201302007).

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Author notes

  1. Wei Huang and Fuxing Pei contributed equally to this work and should be considered as equal corresponding authors.

Authors and Affiliations

  1. Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Yiting Lei & Wei Huang

  2. Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People’s Republic of China

    Yiting Lei, Zeyu Huang, Qiang Huang & Fuxing Pei

Authors
  1. Yiting Lei
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  2. Zeyu Huang
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  3. Qiang Huang
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  4. Fuxing Pei
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  5. Wei Huang
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Corresponding authors

Correspondence to Fuxing Pei or Wei Huang.

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All authors declare no conflict of interest.

Ethical approval

The trial was approved by the institutional review board (2017-128) and registered the International Clinical Trial Registry (ChiCTR1800016865).

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Informed consent was obtained from all individual participants included in the study.

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Lei, Y., Huang, Z., Huang, Q. et al. Dose optimization of intravenous dexamethasone for total knee arthroplasty: when two is not better than one. Arch Orthop Trauma Surg 142, 665–672 (2022). https://doi.org/10.1007/s00402-021-03859-3

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  • DOI: https://doi.org/10.1007/s00402-021-03859-3

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