Single-Dose Dexamethasone Reduces Dynamic Pain After Total Hip Arthroplasty

Kardash, Kenneth J.; Sarrazin, Frederic; Tessler, Michael J.; Velly, Ana Míriam

doi:10.1213/ane.0b013e318164f319

Cited by 165 publications

(183 citation statements)

References 25 publications

Supporting

Mentioning

173

Contrasting

Unclassified

Order By: Relevance

“…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.…”

Section: Discussionmentioning

confidence: 56%

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

Koh

Chang

Lee

et al. 2013

Clinical Orthopaedics &Amp; Related Research

112

147

View full text Add to dashboard Cite

Background Dexamethasone is a potent analgesic and antiemetic. However, the benefit of dexamethasone after TKA is unclear, as is the efficacy in a current multimodal regime. Questions/purposes We determined (1) whether the addition of dexamethasone to a protocol including ramosetron further reduces postoperative emesis compared with ramosetron alone; (2) whether it reduces postoperative pain; and (3) whether it increases the risk for wound complications in a current multimodal regime after TKA. Methods We randomized 269 patients undergoing TKAs to receive dexamethasone (10 mg) 1 hour before surgery and ramosetron immediately after surgery (Dexa-Ra group, n = 135), or ramosetron alone (Ra group, n = 134). We recorded the incidence of postoperative nausea and vomiting (PONV), severity of nausea, incidence of antiemetic requirement, complete response, pain level, and opioid consumption. Patients were assessed 0 to 6, 6 to 24, 24 to 48, and 48 to 72 hours postoperatively. In addition, patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery. Results The Dexa-Ra group had a lower incidence of PONV during the entire 72-hour evaluation period and experienced less severe nausea for the first 6 hours after TKA, although not between 6 to 72 hours.

show abstract

Section: Discussionmentioning

confidence: 56%

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

Koh

Chang

Lee

et al. 2013

Clinical Orthopaedics &Amp; Related Research

112

147

View full text Add to dashboard Cite

show abstract

“…A single preoperative dose of dexamethasone is a proven long-acting prophylactic agent for nausea and vomiting, and improves postoperative pain and mobilization (Kardash et al 2008, Lunn and Kehlet 2013). A single dose of dexamethasone has no known side effects either in the short term or long term, apart from increased blood glucose level on the first postoperative day (Waldron et al 2013).…”

Section: Discussionmentioning

confidence: 99%

“…Multimodal analgesia in THA usually includes analgesics such as opioids, gabapentin, NSAIDs, acetaminophen, glucocorticoids, and local infiltration (Kardash et al 2008, Kerr and Kohan 2008, Toms et al 2008, Fredheim et al 2011, Maund et al 2011, Zhang et al 2011). …”

mentioning

confidence: 99%

Perioperative local infiltration anesthesia with ropivacaine has no effect on postoperative pain after total hip arthroplasty

et al. 2015

View full text Add to dashboard Cite

Background and purpose — The local infiltration analgesia (LIA) technique has been widely used to reduce opioid requirements and to improve postoperative mobilization following total hip arthroplasty (THA). However, the evidence for the efficacy of LIA in THA is not yet clear. We determined whether single-shot LIA in addition to a multimodal analgesic regimen would reduce acute postoperative pain and opioid requirements after THA.Patients and methods — 116 patients undergoing primary THA under spinal anesthesia were included in this randomized, double-blind, placebo-controlled trial. All patients received oral opioid-sparing multimodal analgesia: etoricoxib, acetaminophen, and glucocorticoid. The patients were randomized to receive either 150 mL ropivacaine (2 mg/mL) and 0.5 mL epinephrine (1 mg/mL) or 150 mL 0.9% saline. Rescue analgesic consisted of morphine and oxycodone as needed. The primary endpoint was pain during mobilization in the recovery unit. Secondary endpoints were pain during mobilization on the day after surgery and total postoperative opioid requirements on the first postoperative day.Results — The levels of pain during mobilization—both in the recovery unit and on the day after surgery—and consumption of opioids on the first postoperative day were similar in the 2 groups.Interpretation — LIA did not provide any extra analgesic effect after THA over and above that from the multimodal analgesic regimen used in this study.

show abstract

“…Given i.v., several steroids have been shown to improve postoperative pain and reduce postoperative nausea and vomiting [26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone as An Additive to Bupivacaine in Fascia Lliaca Compartment Block: A Prospective, Randomized and Double Blind Study

Kumar

Sebastian

2014

JCDR

View full text Add to dashboard Cite

Background: Patients with fracture femur experience severe pain on movement during positioning for spinal anaesthesia. Fascia Iliaca Compartment Block (FICB) has been used effectively for providing analgesia during positioning of the patient for spinal anaesthesia. Aim:To test the hypothesis that, adding dexamethasone would significantly prolong the duration of Bupivacaine in FICB. Materials and Methods:Sixty patients aged 18 to 80 years posted for ORIF (Open Reduction and Internal Fixation) of fracture femur were included to receive FICB. This was a prospective, randomized, double blind study done at tertiary medical college hospital. Thirty patients received 38ml of 0.25 % bupivacaine with 2ml saline and another 30 patients received 38ml of 0.25 % bupivacaine with 2ml dexamethasone (8mg). Thirty minutes after FICB, patient satisfaction during positioning for spinal anesthesia was recorded. In the post-operative period, duration of analgesia and the total doses of rescue analgesics were recorded in both the groups. Results:Patients who received Bupivacaine with dexamethasone had significant prolongation of analgesia and required fewer doses of rescue analgesics as compared to patients who received Bupivacaine alone for FICB. However, the onset of analgesia, VAS scores and patient satisfaction during positioning for spinal anaesthesia were similar in both groups. Conclusion:Our study shows that adding Dexamethasone (8mg) to Bupivacaine for FICB significantly prolonged the duration of block and decreased the requirement of rescue analgesics as compared to patients who received Bupivacaine alone. FICB is relatively easy and safe to perform. In our study we did not encounter any complication while doing the procedures and also by adding dexamethasone.

show abstract

Single-Dose Dexamethasone Reduces Dynamic Pain After Total Hip Arthroplasty

Abstract: A single, preoperative i.v. dose of dexamethasone 40 mg has a prolonged suppressive effect on the inflammatory response and decreases dynamic pain 24 h after total hip arthroplasty.

Cited by 165 publications

References 25 publications

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

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

Perioperative local infiltration anesthesia with ropivacaine has no effect on postoperative pain after total hip arthroplasty

Dexamethasone as An Additive to Bupivacaine in Fascia Lliaca Compartment Block: A Prospective, Randomized and Double Blind Study

Contact Info

Product

Resources

About