Objective To evaluate the efficacy and safety of two low-dose dexamethasone in the perioperative period of total hip arthroplasty (THA) with a single-center randomized controlled trial.Method 98 patients who underwent THA received two low-dose (10 mg) IV-dexamethasone (group dexa) or IV- isotonic saline group (The placebo).The post-operative day 24 h,48 h,72 h c reactive protein (CRP) and interleukin-6(IL-6), the pain VAS scores at rest and mobilization, the incidence of postoperative nausea and vomiting (PONV), nausea VAS score, postoperative fatigue rating and analgesia and antiemetic, the postoperative lengh of stay (PLOS), wound problems and complications were recorded and compared.Results The inflammatory markers (CRP, IL - 6) level postoperative 24,48,72 hours in dexa group of was lower than the placebo group (P<0.05).The 24 hours of rest and dynamic pain VAS score in dexa group was lower than those in blank group (P<0.05).The incidence of PONV, nausea VAS score, fatigue ICFS score in dexa group was lower than the blank group (P<0.05) and the dosage of analgesic and antiemetic were decreased significantly (P<0.05).In addition, the PLOS of dexa group was shorter than the blank group (P< 0.05).There was no significant difference in perioperative complications between the two groups (P> 0.05).Conclusion The application of two low-dose dexamethasone in the perioperative period of THA can effectively reduce the postoperative CRP and IL-6 levels, reduce pain, nausea, postoperative fatigue and the use of opioid analgesics, shorten the PLOS, without increasing the risk of incision infection or gastrointestinal hemorrhage.
Objective: To evaluate the efficacy and safety of perioperative cryotherapy combined with intra-articular injection of tranexamic acid (TXA) in total knee arthroplasty (TKA) and explore a new strategy of enhanced recovery after TKA. Methods: We randomly divided 200 patients into 4 groups: normal saline (10 mL) by drainage (Group A, placebo); intra-articular injection of TXA (1 g, 10 mL, Group B); normal saline (10 mL) and continuous cryotherapy postoperatively (Group C) and intra-articular injection of TXA (1 g, 10 mL) and continuous cryotherapy postoperatively (Group D). Primary outcomes were blood loss volume, postoperative pain and circumference variation. We also recorded consumption of analgesics, postoperative length of stay (p-LOS), range of motion (ROM), function score (Hospital for Special Surgery) and severe complications. Results: There were statistically significant differences in postoperative drainage volume, total blood loss, hidden blood loss, and visual analogue scale at rest and walking on postoperative day 1 (POD1), POD2, POD3, ROM (POD3, 7, discharge, postoperative month), circumference variation (POD3, 7), p-LOS, Hospital for Special Surgery score (discharge) and drop of hemoglobin on POD3 (P < .05) among 4 groups, but there were no significant differences in intraoperative blood loss, postoperative prothrombin, activated partial thromboplastin time, overall number of patients or total consumption of oxycodone and perioperative complications (e.g., incidence of surgical site infection, deep venous thrombosis, and cold injury) among them (P > .05). Conclusion: Continuous cryotherapy combined with intra-articular injection of TXA provides short-term advantages in reducing blood loss, pain, postoperative swelling, p-LOS and increasing ROM and joint function in the early postoperative period after TKA without increasing any severe complications.
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