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

Abstract

Background Intraoperative periarticular injection of corticosteroid effectively reduces perioperative pain in total knee arthroplasty (TKA). However, which corticosteroid is most effective for intraoperative periarticular injection remains controversial. We compared the effects of corticosteroids between dexamethasone and triamcinolone acetonide periarticular administration for reducing pain and postoperative nausea and increasing fasting blood glucose concentrations during the perioperative period following TKA. Methods One hundred and two patients who underwent TKA from August 2018 to September 2020 were divided into two groups: one received 10 mg dexamethasone for intraoperative periarticular injection and another receiving 40 mg triamcinolone acetonide. Postoperative pain scores at rest and during walking and nausea scores were recorded using a 0-to-10 Numerical Rating Scale. C-reactive protein (CRP) and fasting blood glucose levels were measured pre- and postoperatively. Results Pain scores in the triamcinolone group were significantly lower than in the dexamethasone group at rest 7 days postoperatively (1.5 vs. 2.0; p = 0.046) and while walking at both 72 h (3.9 vs. 4.8; p = 0.008) and 7 days postoperatively (3.2 vs. 4.0; p = 0.03). The CRP levels in the triamcinolone group were significantly lower than in the dexamethasone group at 7 days postoperatively (1.6 mg/dl vs. 3.0 mg/dl: p < 0.001). The fasting blood glucose levels at 1 day postoperatively were increased in both groups but not significantly different between the groups. No significant differences in the nausea score were noted between the groups. Conclusions Triamcinolone acetonide periarticular administration provided greater pain relief by reducing inflammation to a greater degree than dexamethasone.

The efficacy and safety of perioperative glucocorticoid for total knee arthroplasty: a systematic review and meta-analysis

“…In addition, referring to the concern of hyperglycemia caused by the administration of corticosteroids, previous studies indicated that the fasting blood glucose of patients treated with topical and intravenous glucocorticoid was significantly increased after TKA [ 52 , 97 , 98 ], which was similar to significant elevation of blood glucose in the glucocorticoid group on POD1 in the study. Hyperglycemia, especially when levels exceed 200 mg/dl has been associated with an increased risk of surgical site infection and wound complications [ 99 , 100 ].…”

Comparing the effect of local injection of combined morphine, triamcinolone and lidocaine and lidocaine injection on pain intensity after mastoidectomy-tympanoplasty; a triple-blind clinical trial

“…Triamcinolone is a long-acting steroid conducted in chronic pain as a local injection. Due to its antiinflammatory properties, it is helpful in controlling pain after ophthalmic and orthopedic surgeries (8). Moreover, its local use in tonsillectomy is effective in head and neck surgery (9).…”