Perioperative Dexamethasone Does Not Affect Functional Outcome in Total Hip Arthroplasty

Abstract

Current trends in orthopaedic surgery have explored different forms of adjuvant treatments to minimize postoperative pain and the risk of nausea and vomiting. A small single preoperative dose of dexamethasone, as part of a comprehensive multimodal analgesic regimen in low-risk patients undergoing total hip arthroplasty (THA), provides antiemetic and opioid-sparing effects but the longer-term effects on pain, complications, or function are not known. We therefore asked whether such a routine would affect longer-term pain, complications, or function. Fifty patients undergoing elective primary THA using spinal anesthesia were initially randomized to receive either dexamethasone (40 mg intravenous) or saline placebo. The patients, anesthesiologists, nurses, and research coordinators were blinded to the study arms. The functional outcome was measured using the Harris hip score. Outcomes were assessed 6 weeks and 1 year postoperatively. We observed no difference in resting pain between the two groups at either time period.

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

“…Our findings agree with those of previous small series [15,36,38,40] and reviews of numerous perioperative settings [19,21,22,46] that found no association between corticosteroid use and increased risk for postoperative wound infection. Furthermore, studies using higher corticosteroid doses than that used in our study showed no increase in postoperative wound infection after major orthopaedic surgeries [1,5,19,25,46]. The rate of periprosthetic joint infections after primary TKA at our institute was 0.6% (8/1323 patients) between 2006 and 2009 [50], and we have maintained the same operating room environment, surgical scrub, skin preparation, and antibiotic prophylactic protocol since 2003.…”

Infection after urogynecologic surgery with the use of dexamethasone for nausea prophylaxis

“…One animal study found that a single dose of dexamethasone negatively impacted wound healing in rats [11]. A study analyzing postoperative functional outcomes and infectious complications in patients undergoing total hip arthroplasty during spinal anesthesia found no increase in wound or deep infections following single-dose dexamethasone [19]. Another retrospective cohort study of patients who received perioperative dexamethasone for various nonemergency surgical procedures found no association with increased postoperative infection [20].…”

Review Article: Perioperative Care in Enhanced Recovery for Total Hip and Knee Arthroplasty

“…Glucocorticoids, as antiemetics, can inhibit prostaglandin and/ or endogenous opioid synthesis. 39 However, of the 22 studies reviewed, only 3 used preoperative intravenous dexamethasone 4 to 10 mg, with one giving 10 mg the night prior to surgery. 6,19,20 A single dose of dexamethasone 40 mg given before THA has no deleterious effects on function and complications (infection and osteonecrosis of the contralateral hip) in the medium to long term (one year).…”

“…6,19,20 A single dose of dexamethasone 40 mg given before THA has no deleterious effects on function and complications (infection and osteonecrosis of the contralateral hip) in the medium to long term (one year). 39 Patients receiving dexamethasone have superior dynamic hip pain scores than those receiving placebo. 40 Preoperative dexamethasone plus pregabalin significantly reduces the incidence of postoperative nausea and vomiting, compared with pregabalin alone.…”