Relationship between dexamethasone added to periarticular anesthetic infiltration and postoperative nausea and vomiting following total knee arthroplasty under general anesthesia: a retrospective observational study

Abstract

Background: Periarticular anesthetic infiltration (PAI) with a corticosteroid is a modality for pain control following total knee arthroplasty (TKA). Systemic corticosteroids are an established antiemetic for the prophylaxis of postoperative nausea and vomiting (PONV). The purpose of this retrospective observational study was to elucidate the relationship between dexamethasone added to PAI and PONV in patients who underwent TKA. Methods: Data from 435 patients who received PAI using ropivacaine with or without dexamethasone were reviewed. The primary outcome was the incidence of PONV within 24 h following TKA. The incidence of deep incisional and organ/space surgical site infection (SSI) within the first year was also assessed. Results: The overall incidence of PONV was 23.2%. A multivariate logistic regression analysis showed that dexamethasone added to PAI was independently associated with a reduced incidence of PONV (adjusted odds ratio, 0.23; 95% confidence interval, 0.12-0.44, P < 0.001). The incidence of PONV and rescue analgesic requirements within 24 h were lower in patients who received PAI with dexamethasone than in those who received PAI alone (19.5% vs 49.1%, P < 0.001, 7.9% vs 29.1%, P < 0.001, respectively). SSI developed in one out of the 55 patients who received PAI alone, but in none of those who received PAI with dexamethasone. Conclusions: Dexamethasone added to PAI for postoperative pain management was independently associated with a lower risk of PONV within 24 h of TKA.

The comparison of dexamethasone and triamcinolone periarticular administration in total knee arthroplasty: retrospective cohort study

“…Most postoperative nausea occurs during the first 24 h after surgery, and the intravenous administration of dexamethasone effectively prevents postoperative nausea [ 2 , 3 ]. Periarticular administration also had a postoperative antiemetic effect [ 23 ]. Another study showed that periarticular injection of corticosteroids had a similar antiemetic effect to intravenous administration [ 9 ].…”

Should corticosteroids be administered for local infiltration analgesia in knee arthroplasty? A meta‐analysis and systematic review

“…Two independent investigators (Huang LY and Hu HH) screened the article titles and abstracts, identifying 36 studies as being potentially relevant. After 20 trials were excluded for failing to meet the selection criteria, the remaining 16 articles were included in the systematic review 4,5,9,15–17,24–33 …”

“…Two retrospective studies were not combined for synthetic control evaluation 32,33 . Ultimately, 14 RCTs met all the criteria and were assessed in the meta‐analysis 4,5,9,15–17,24–31 …”

Efficacy of Corticosteroid Addition to a Periarticular Cocktail Injection to Counteract Nausea and Vomiting After Total Knee Arthroplasty

“…We investigated whether a cocktail injection containing a corticosteroid had an antiemetic effect by recording the number of patients who complained of nausea or by using antiemetic agents. Yano et al [ 14 ] and Ikeuchi et al [ 11 ] reported that fewer patients complained of nausea in a group that received a cocktail injection containing a corticosteroid. Conversely, Deng et al reported that corticosteroid-containing cocktail injections did not affect the prevalence of nausea and vomiting [ 15 ].…”