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Postoperative Systemic Steroid Can Control Pain and Nausea in Total Knee Arthroplasty : Prospective Randomized Controlled Study
ESSKA Academy. Lee M. May 11, 2018; 218085; FP37-735
Myung Chul Lee
Myung Chul Lee
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Abstract
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Objectives: Most of studies have reported on single shot dexamethasone administration immediately prior to or during surgery to control pain and nausea after total knee arthroplasty (TKA). Therefore, this study was conducted to find the optimal dosage and time by comparing the effects of dexamethasone administration at 24 hours after surgery with the group with administration just before surgery and the control group.

Methods: A prospective randomized double blinded and placebo-controlled comparative study was conducted. From October 2015 to April 2017, a total of 184 patients scheduled to receive unilateral TKA were randomly assigned to either a control group (Group I, n = 46), group receiving 10 mg of Dexamethasone IV injection 1 hour before surgery, (Group II, n = 46), group receiving Dexamethasone injection at a dose of 0.1 or 0.2 mg / kg body weight at 24 hours after surgery (Group III, n = 46 or Group IV, n = 46). We measured the daily pain and nausea intensity using Visual Analogue Scale (VAS). The total analgesic dose used was measured using morphine equivalent and any postoperative complications were recorded.

Results: The degree of pain and nausea were maintained high until 48 hours postoperatively (Mean pain and nausea VAS POD 1st and 2nd day: 5.0 and 4.9/ 2.7 and 2.4).When Group 3 and 4 were compared with control group respectively, at 48 hours after surgery, pain VAS improved significantly (4.9 vs 4.2/ 4.9 vs 3.67) and the amount of analgesics used was significantly lower (84 vs 70/ 84 vs 71). However, there was no statistically significant difference in pain levels between Group 3 and 4 which differed in dose. Group 2 had significantly improved pain at 24 hours postoperatively compared with the control group (5.0 vs 3.6), but the degree of improvement was not statistically significant at 48 hours postoperatively. When Group 3 and 4 were compared with control group respectively, at 48 hours after surgery, nausea VAS was significantly improved (2.4 vs 0.8/ 2.4 vs 1.0). However, when Group 3 and 4 were compared, the change in the degree of nausea was not significant. Group 2 showed a significant improvement in nausea compared with the control group at 24 hours postoperatively (2.7 vs 2.1), but the improvement was not statistically significant at 48 hours postoperatively. Regarding postoperative complications,there was one case of hemarthrosis in Group 4.

Conclusions: The use of dexamethasone at 24 hours after surgery is effective in the subsequent 24 hours, but the use of it immediately before surgery is effective only up to 24 hours after surgery. Therefore, when considering patients are still suffering from pain and nausea for more than 48 hours postoperatively, additional systemic dexamethasone use should be considered for up to 24 hours postoperatively. In addition, there was no significant difference according to the dose. Therefore, it would be useful to use the minimum dose considering complications that may occur after steroid use.

Keywords:
dexamethasone, total knee arthroplasty, steroid, pain, nausea
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