A retrospective analysis of the use of intravenous dexamethasone for postoperative nausea and vomiting in total joint replacement

Abstract

Background Multimodal perioperative pain-management protocols have contributed to the success of elective total joint replacement in orthopedic surgery. General or neuraxial anesthesia for arthroplasty is accompanied by complications such as pruritis, nausea, and vomiting. Dexamethasone has been demonstrated to be a safe perioperative antiemetic. This study evaluates the benefit of low-dose intravenous dexamethasone used in the perioperative period to prevent postoperative nausea and vomiting. Methods Two scheduled doses of 8 mg of dexamethasone 12 hours apart after total hip arthroplasty or total knee arthroplasty were given to a dexamethasone group (n = 492) and were retrospectively compared with a no-dexamethasone group (n = 364) based on the use of antiemetics in the postoperative period. Frequency of antiemetic use in both groups was compared using a zero-inflated fixed-model Poisson distribution. Additional analysis included need for opioid analgesic, administration of diphenhydramine, and postoperative infection rates at 30 and 90 days. Results The dexamethasone group was found to have a significant reduction in need for the rescue antiemetic ondansetron ( P = .00194). There was an associated reduction in length of stay for the treatment group (mean 1.83 days) relative to the control group (mean 2.17 days) ( P < .001). There was no significant difference in postoperative infection rates at 30 or 90 days after arthroplasty. Conclusions Dexamethasone is a safe adjunct to perioperative protocol that may reduce nausea, thus improving patient satisfaction. There is an associated reduction in length of stay that may reduce cost of hospitalization.

Efficacy of Preoperative Usage of Dexamethasone in Diabetic Patients Undergoing Total Hip or Knee Arthroplasty for Control of Nausea and Vomiting

“…The current use of dexamethasone preoperatively, intraoperatively, and postoperatively in diabetic patients undergoing surgery has been to control postoperative nausea, vomiting, and pain, and many studies have revealed a significant correlation between the use of dexamethasone and decreased postoperative pain, nausea, and emesis. [7][8][9][10][11] However, fewer studies have shown no significant correlation between dexamethasone use and effect on the reduction of postoperative nausea and vomiting. [12][13][14] Research studies that track the effect of dexamethasone usage on the control of glucose levels in postoperative diabetic patients are few.…”

The role of perioperative intravenous low-dose dexamethasone in rapid recovery after total knee arthroplasty: a meta-analysis

“…[39][40][41] However, our study found that 10 to 20 mg of intravenous dexamethasone is also effective in preventing PONV. Bustos et al 42 found that two scheduled doses of 8 mg of dexamethasone seemed to be a safe adjunct to the perioperative protocol that reduced PONV. This seems to be in agreement with perioperative intravenous low-dose dexamethasone for prophylactic PONV.…”

Efficacy and safety analysis of dexamethasone-lipiodol emulsion in prevention of post-embolization syndrome after TACE: a retrospective analysis

“…Liu et al [ 18 ] reported that dexamethasone could significantly reduce the incidence of POV in postoperative and few adverse effects were reported. Bustos et al [ 19 ] found that dexamethasone is a safe adjunct to perioperative protocol that may reduce nausea, thus improving patient satisfaction, and there is an associated reduction in length of stay that may reduce cost of hospitalization. The findings of Moheimani et al [ 20 ] showed that a single preoperative dose of i.v.…”