The AAHKS Best Podium Presentation Research Award: A Second Dose of Dexamethasone Reduces Postoperative Opioid Consumption and Pain in Total Joint Arthroplasty

Arraut, Jerry; Thomas, Jeremiah; Oakley, Christian T; Barzideh, Omid; Rozell, Joshua C.; Schwarzkopf, Ran

doi:10.1016/j.arth.2023.02.007

Cited by 5 publications

(3 citation statements)

References 39 publications

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“…Perioperative glucocorticoids did not significantly increase the incidence of hyperglycemia in our patients following total joint arthroplasty. This finding contradicts previous studies that have linked glucocorticoid use to hyperglycemia after total joint arthroplasty in diabetic patients, 19,20 but not in patients with well-controlled glycemic levels. 21 Considering the presence of abnormal glucose metabolism in diabetic patients, the administration of corticosteroids at doses exceeding physiological levels may disrupt the delicate balance and result in an increased incidence of hyperglycemia.…”

Section: Hyperglycemia and Hypotensioncontrasting

confidence: 99%

Perioperative Short‐Term Glucocorticoids Do Not Increase Incidence of Complications after Total Joint Arthroplasty in Patients with Rheumatoid Arthritis

Lai,

Huang,

Cai

et al. 2024

Orthopaedic Surgery

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ObjectivesThe safety and analgesic efficacy of perioperative glucocorticoids have been established for patients without rheumatoid arthritis. Therefore, our study aims to investigate whether similar benefits can be observed in patients with rheumatoid arthritis undergoing total joint arthroplasty. Specifically, we aim to explore the impact of perioperative glucocorticoid use on postoperative complications, opioid consumption, incidence of hypotension, hyperglycemia, 30‐day mortality, and 90‐day re‐admission in this patient population.MethodsApproval for the study protocol was obtained from the Medical Research Ethics Committee at Sichuan University, aligning with the principles outlined in the Declaration of Helsinki. We retrospectively analyzed a consecutive series of patients with rheumatoid arthritis who underwent total joint arthroplasty at our medical center between November 2009 and April 2021 and who were not on chronic glucocorticoid therapy before surgery. Those who received glucocorticoids at any time during hospitalization were compared to those who did not in terms of acute complications within 90 days after surgery as well as postoperative rescue opioid consumption, hypotension, and hyperglycemia during hospitalization. The two groups were also compared in terms of overall duration of hospitalization, all‐cause mortality within 30 days, and readmission for any reason within 90 days. Continuous data were assessed for significance using the independent‐samples t test. Categorical data were assessed using the Pearson chi‐squared test.ResultsOf the 849 patients included in the analysis, 598 administered perioperative glucocorticoids and 251 did not. Prior to surgery, the two groups did not differ significantly in any clinicodemographic variable that we examined. The incidence of acute postoperative complications (2.3% vs. 4.0%, p = 0.187) and acute postoperative infection (2.0% vs. 2.8%, p = 0.482) was comparable between those who received perioperative glucocorticoids and those who did not, but the former group exhibited a significantly lower incidence of rescue opioid use (17.9% vs. 44.6%, p < 0.001) as well as significantly lower total rescue opioid consumption (4.7 ± 2.1 mg vs. 8.9 ± 4.6 mg, p < 0.001). However, the two groups showed similar incidences of postoperative hypotension, hyperglycemia, 30‐day mortality, and 90‐day re‐admission.ConclusionPerioperative glucocorticoids may reduce the need for rescue opioids after total joint arthroplasty of rheumatoid arthritis patients, without increasing the incidence of acute complications, hypotension or hyperglycemia.

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Section: Hyperglycemia and Hypotensioncontrasting

confidence: 99%

Perioperative Short‐Term Glucocorticoids Do Not Increase Incidence of Complications after Total Joint Arthroplasty in Patients with Rheumatoid Arthritis

Lai,

Huang,

Cai

et al. 2024

Orthopaedic Surgery

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“…And there lacks reports on the association of different doses of dexamethasone and postoperative hyperglycemia in patients without diabetes undergoing TJA. Arraut et al observed that in 523 patients with diabetes receiving THA and 953 patients with diabetes receiving TKA, 2 doses of 10 mg dexamethasone was associated with increased postoperative 24-hour and 60-hour BG levels compared to 1-dose cohort, nonetheless, the study was retrospective [21]. Lei et al found no differences in FBG between patients receiving a perioperative 2 doses of 10 mg dexamethasone and a preoperative 20 mg dexamethasone undergoing TJA, however, they included patients with and without diabetes, which compromised the accuracy of the conclusions [11].…”

Section: Discussionmentioning

confidence: 99%

“…There are limited studies demonstrating the impact of dexamethasone on postoperative BG in patients undergoing TJA. Nonetheless, current studies on the association of dexamethasone and BG were all retrospective and there is a lack of high-quality clinical evidence [21,22]. Moreover, the timing and dose of dexamethasone injections were inconsistent, which increased the confounding factors [23][24][25].…”

mentioning

confidence: 99%

The effect of a split-dose intravenous dexamethasone and a single high-dose on postoperative blood glucose after total joint arthroplasty： A randomized double-blind placebo-controlled trial

Liu,

Mou,

Cao

et al. 2024

Preprint

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Background In patients undergoing total joint arthroplasty (TJA), the administration of dexamethasone may contribute to perioperative blood glucose (BG) disturbances, potentially resulting in complications, even in patients without diabetes. This study aimed to demonstrate the impact of different administration regimens of dexamethasone in postoperative BG levels. Methods In this randomized, controlled, double-blind trial, 136 patients without diabetes scheduled for TJA were randomly assigned to three groups: two perioperative saline injections (Group A, placebo); a single preoperative injection of 20 mg dexamethasone and a postoperative saline injection (Group B), and two perioperative injections of 10 mg dexamethasone (Group C). Primary outcomes were the postoperative fasting blood glucose (FBG) levels. Secondary outcome parameters were the postoperative postprandial blood glucose (PBG) levels. Postoperative complications within 90 days were also recorded. Risk factors for FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl were investigated. Results Compared to Group A, there were transient increases in FBG and PBG on postoperative days (PODs) 0 and 1 in Groups B and C. Statistical differences in FBG and PBG among the three groups were nearly absent from POD 1 onward. Both dexamethasone regimens did not increase the risk for postoperative FBG ≥ 140 mg/dl or PBG ≥ 180 mg/dl. Elevated preoperative HbA1c levels may increase the risk of postoperative FBG ≥ 140 mg/dl or PBG ≥ 180 mg/dl, respectively. Conclusion Perioperative intravenous high-dose dexamethasone to patients without diabetes has transient effects on increasing BG levels after TJA. However, no differences were found between the split-dose and single high-dose regimens. The elevated preoperative HbA1c, but not the dexamethasone regimens were the risk factor for FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl. Trial registration Chinese Clinical Trail Registry, ChiCTR2300069473. Registered 17 March 2023, https://www.chictr.org.cn/showproj.html?proj=186760.

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Effects of Dexamethasone on Postoperative Glycemic Control in Diabetic Patients Following Primary Total Joint Arthroplasty: A Retrospective Cohort Study

Arraut

Thomas

Oakley

et al. 2023

The Journal of Arthroplasty

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The AAHKS Best Podium Presentation Research Award: A Second Dose of Dexamethasone Reduces Postoperative Opioid Consumption and Pain in Total Joint Arthroplasty

Cited by 5 publications

References 39 publications

Perioperative Short‐Term Glucocorticoids Do Not Increase Incidence of Complications after Total Joint Arthroplasty in Patients with Rheumatoid Arthritis

Perioperative Short‐Term Glucocorticoids Do Not Increase Incidence of Complications after Total Joint Arthroplasty in Patients with Rheumatoid Arthritis

The effect of a split-dose intravenous dexamethasone and a single high-dose on postoperative blood glucose after total joint arthroplasty： A randomized double-blind placebo-controlled trial

Effects of Dexamethasone on Postoperative Glycemic Control in Diabetic Patients Following Primary Total Joint Arthroplasty: A Retrospective Cohort Study

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