Perioperative intravenous glucocorticoids can decrease postoperative nausea and vomiting and pain in total joint arthroplasty

Chen, Ping; Li, Xiwen; Lin, Shaofeng; Huang, Jiangfa

doi:10.1097/md.0000000000006382

Cited by 23 publications

(14 citation statements)

References 32 publications

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“…The occurrence of HRPOM exposure of patients with surgeries of Grade IV was 91.7% compared with 66.3% for those with surgeries of GradeI, 62.8% for those with surgeries of GradeIIand 74.0% for those with surgeries of Grade III. Glucocorticoids identified in our study were used to prevent or treat postoperative nausea and vomiting, 35,36 airway hyperresponsiveness, 37 allergy and inflammatory complications. The combination of glucocorticoids and NSAIDs increased the risk of gastrointestinal bleeding and ulcer.…”

Section: Discussionmentioning

confidence: 99%

High-Risk Perioperative Medications in the Chinese Elderly Population

Wang

Ren

Tan

et al. 2021

CIA

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Background: Inappropriate perioperative medications among elderly patients increase the risk of adverse events and undermine surgical outcomes. This study aimed to assess the prevalence of high-risk medications in elderly surgical patients and verify the effectiveness of a new-developed high-risk perioperative medications (HRPOMs) list for the elderly. Methods: A cross-sectional, single-center study was conducted at Jinshan Hospital of Fudan University. A total of 810 elderly surgical patients were included in the study. The HRPOMs list was applied to patients' data to identify the HRPOMs including chronic medications and medications related to surgery. Results: A total of 2113 HRPOMs were identified in 810 patients who fulfilled the inclusion criteria. Of these, 1067 (50.5%) involved medications related to surgery, and 982 (46.5%) involved chronic medications. The prevalence of HRPOM exposure, which was defined as at least one HRPOM was 76.3%. Patients that were 70 years or older (adjusted odds ratio [AOR] =2.118, 95% confidence interval [CI], 1.420~3.159), hospitalized over two weeks (AOR =4.192, 95% CI, 1.493~11.771), with more than 2 distinct diagnoses (AOR =3.407, 95% CI, 2.224~5.220) and with 16 or more medications during hospitalization were more likely to be exposed to HRPOMs. Patients who underwent surgeries of Grade IV were at 1.73 increased odds of HRPOM exposure compared with those who received surgeries of Grade III or lower (P=0.071). Conclusion:HRPOMs are more common in patients of 70 years or older, with 3 or more distinct diagnoses, with 16 or more medications and hospitalized for 15 days or longer. Our study showed the validity of the HRPOMs list in the perioperative medication review for the elderly and may induce further research to reveal the impact of HRPOMs upon the surgical outcomes of the elderly.

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Section: Discussionmentioning

confidence: 99%

High-Risk Perioperative Medications in the Chinese Elderly Population

Wang

Ren

Tan

et al. 2021

CIA

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“…Although post-operative nausea and vomiting are rarely associated with a lifethreatening condition, they are frequent undesirable side effects of surgery and anaesthesia. Several drugs have been studied to prevent such unpleasant symptoms and the most effective seems to be dexamethasone given pre or intraoperatively at the time of anaesthesia [77]. a topic for debate.…”

Section: Gastrointestinal Complicationsmentioning

confidence: 99%

Post-operative Management

Pioli

Bendini

Pignedoli

2020

Practical Issues in Geriatrics

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The management of hip fracture in older people in the post-operative setting requires a multidisciplinary approach and geriatric competencies. The main goals of the post-operative stage are early mobilisation and prevention of complications. To achieve the goal of early mobilisation a stable surgical repair is essential, allowing the patient to bear weight as tolerated, as well as effective pain control and fluid management protocols, ensuring an adequate volume and avoiding orthostatic hypotension. Due to the age-related decline of the physiological reserve and function across multi-organ systems, patients with hip fracture are at risk of multiple complications. Almost every organ is vulnerable, although cognitive dysfunction, cardiac complications and infections are the most frequent and clinically significant. In most common conditions a systematic approach in the management of hip fracture, through a checklist for each professional and shared protocols, is an established method to improve the quality of the intervention and reduce post-operative complications. The vulnerability to complications of older patients with hip fractures may last for several days after surgical repair. However, this group of patients is at high risk of deconditioning in hospital and thus early discharge-planning based on discharge needs is a crucial component in the management of the acute episode.

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“…Some 0.45% of all THAs are performed as part of bilateral procedures [1]. The use of peri-operative steroid administration has been shown to enhance recovery in unilateral THA in relation to reduced post-operative pain (as measured using a VAS), nausea and vomiting [2,3] and length of stay [4]. There has, however, been no report of the impact of steroid administration on perioperative analgesic requirements in simultaneous bilateral THA.…”

Section: Introductionmentioning

confidence: 99%

Perioperative dexamethasone administration reduces ‘on-demand’ opioid requirements in bilateral total hip arthroplasty

2021

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Background Bilateral joint arthroplasty is currently not common, but its usage is expected to increase in the future. This may result in larger amounts of opioids being consumed by patients due to anticipated increased pain and prolonged recovery from this procedure. Aim We describe the impact of perioperative steroid administration in a cohort of bilateral total hip arthroplasties (THAs) (44 hips) in relation to post-operative opioid consumption. Methods We report a single-surgeon consecutive case series of simultaneously performed bilateral THAs. Nine patients received two doses of 8 mg IV dexamethasone in the perioperative setting. There were 13 patients in the control group that received no dexamethasone. The primary outcome measure was post-operative analgesic requirements (mg/mcg). Secondary outcomes included post-operative pain according to the visual analogue score (VAS), anti-emetic requirements (mg) and length of stay (days). Results The mean 'on-demand' Oxynorm® (IR oxycodone) usage in the 'steroid' group was lower than the 'non-steroid' group (47 mg vs 111 mg) (p = 0.005). There was also a significant decrease in the mean consumption of pregabalin in the 'steroid' group when compared with the 'non-steroid' group-464 mg versus 570 mg (p = 0.000). There was no reduction in the requirement of 'regularly' prescribed opioid analgesic medications. VAS analysis demonstrated no significant difference between the two groups at any timepoint. The 'steroid' group did have a trend towards a lower total LOS at 4.6 days compared with 5.5 days in the 'non-steroid' group (p = 0.0503). Conclusions We recommend the use of perioperative steroids in bilateral THA to reduce the consumption of potentially problematic opioid-based analgesics.

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Perioperative intravenous glucocorticoids can decrease postoperative nausea and vomiting and pain in total joint arthroplasty

Abstract: Supplemental Digital Content is available in the text

Cited by 23 publications

References 32 publications

High-Risk Perioperative Medications in the Chinese Elderly Population

High-Risk Perioperative Medications in the Chinese Elderly Population

Post-operative Management

Perioperative dexamethasone administration reduces ‘on-demand’ opioid requirements in bilateral total hip arthroplasty

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