Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial

Abstract

Editor's key points † There is considerable interest in the effects of steroids in the perioperative period. † There is already evidence of beneficial effects on pain and nausea, although not in this patient population. † Using predefined criteria, this study comprehensively assessed the postoperative effects of i.v. methylprednisolone (MP) on function and pain. † There was no improvement in functional discharge criteria using MP, although pain control was better.Background. High-dose glucocorticoid may reduce postsurgical pain and improve recovery. We hypothesized that 125 mg methylprednisolone (MP) would reduce time to meet functional discharge criteria after total hip arthroplasty (THA).Methods. Forty-eight patients undergoing unilateral THA under spinal anaesthesia were consecutively included in this randomized, double-blind, placebo-controlled trial receiving preoperative i.v. MP or saline. All patients received a standardized, multimodal analgesic regime with paracetamol, celecoxib, and gabapentin. The primary outcome was time to meet well-defined functional discharge criteria. Secondary outcomes were handgrip strength and endurance, pain, nausea, vomiting, fatigue, sleep quality, and rescue analgesic-, antiemetic-, and hypnotic medicine requirements. The inflammatory response measured by C-reactive protein (CRP) and actual length of stay were also registered. Discharge criteria were assessed twice daily (at 09:00 and 14:00 h) until discharge. Other outcomes were assessed at 2, 4, 6, 8, and 24 h after operation, and also in a questionnaire from postoperative day (POD) 1-4. Results. Time to meet discharge criteria was [median (IQR) (95% CI), MP vs placebo]: 23.5 (23.3 -23.7) (17.8 -43.8) vs 23.5 (23.0 -23.8) (20.0 -46.8) h, the mean difference (95% CI) being 21.3 (24.7 to 2.2) h, P¼0.65. Overall pain for the first 24 h after surgery was significantly reduced in the MP vs the placebo group (P,0.01), as was CRP at 24 h (P,0.0001). No other between-group differences were observed. No drug-related complications were observed at follow-up on POD30.Conclusions. MP 125 mg i.v. before surgery added to a multimodal oral analgesic regime did not reduce time to meet functional discharge criteria after THA, but improved analgesia for the first 24 h.

Effect of Intravenous Methylprednisolone on Pain after Intertrochanteric Femoral Fracture Surgery

“…The present study supported the above findings and indicated that Methylprednisolone can significantly suppress inflammatory response (CRP) which is also consistent with the finding by Lunn and Bisgaard who indicated Methylprednisolone causes fatigue reduction after surgery which in turn, can justify reduced inflammatory response [22,23,27]. …”

“…Overall, pain in three states, rest, hip flexion, and walking, was significantly lower in the MP group than the C group. This finding was similar to Romundstad and Lunna's studies that showed administration of MP after surgeries as single-dose (125 mg) can significantly reduce Post-operative pain in patients [14,23,27,31]. Methylprednisolone belongs to the glucocorticoids group with low power and 125 mg of it equals to 25 mg Dexamethasone and has mild Mineralocorticoid effects.…”

“…Advantages of using Glucocorticoids and their effectiveness after surgery need further clinical studies. Few works have investigated effectiveness of high dosages of Glucocorticoids on reduced pain after major surgeries especially in orthopedic surgeries [27]. The current study continues previous studies by investigating the effect of single-dose methylprednisolone 125 mg on reduced pain in patients with stable intertrochanteric unilateral fracture who were candidate for Open Reduction Internal Fixation (ORIF) surgery electively.…”

Postoperative orthostatic intolerance: a common perioperative problem with few available solutions

“…Although the prevalence of OI was not significantly reduced with midodrine (risk ratio, 0.63; 95% confidence interval, 0.36 to 1.10; P = 0.10), further studies with higher dosing and earlier premobilization administration may be warranted. Furthermore, targeting the postoperative inflammatory response with high-dose systemic glucocorticoids-which has shown to have some effect on reducing pain, opioid requirements, inflammatory response, and early fatigue after THA, TKA, 18,19 and endovascular aortic aneurism repair-20 could potentially reduce the incidence of OH and OI during early postoperative mobilization. Indeed, this is currently being studied in THA patients (www.…”

“…Bien que la midodrine n'ait pas réduit la prévalence d'IO de façon significative (risque relatif, 0,63; intervalle de confiance 95 %, 0,36 à 1,10; P = 0,10), d'autres études examinant des doses plus élevées et une administration pré-mobilisation plus hâtive pourraient être de mise. De plus, le ciblage de la réponse inflammatoire postopératoire à l'aide de fortes doses de glucocorticoïdes systémiques -dont les effets sur la réduction de la douleur, des besoins en opioïdes, de la réponse inflammatoire et de la fatigue précoce après une ATH et une ATG, 18,19 et sur la réparation d'un anévrisme aortique endovasculaire, 20 ont été démontrés -pourrait potentiellement réduire l'incidence d'HO et d'IO pendant la mobilisation postopératoire précoce. En fait, une étude est actuellement en cours auprès de patients subissant une ATH (www.ClincialTrials.gov; no.…”