• Chan Timmy Chi Wing TCW From the Department of Anaesthesiology, Queen Mary Hospital (TCWC, AYFC), Department of Anaesthesiology, University of Hong Kong (CWC, SSCW, MGI),, Chi Wai Cheung, Wong Stanley Sau Ching SSC, Arthur Yu Fai Chung, Michael G Irwin, Ping Keung Chan, Henry Fu, Chun Hoi Yan, and Kwong Yuen Chiu.
• From the Department of Anaesthesiology, Queen Mary Hospital (TCWC, AYFC), Department of Anaesthesiology, University of Hong Kong (CWC, SSCW, MGI), Department of Orthopaedics and Traumatology, Queen Mary Hospital (PKC, HF), Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, China (CHY, KYC).
• Eur J Anaesthesiol. 2020 Dec 1; 37 (12): 1157-1167.

BackgroundCorticosteroids can reduce pain but the optimal dose and safety profiles are still uncertain.ObjectiveThis study aimed to evaluate two different doses of dexamethasone for pain management and their side effects after total knee arthroplasty.DesignA prospective randomised, controlled trial.SettingA tertiary teaching hospital in Hong Kong.PatientsOne hundred and forty-six patients were randomly allocated to one of three study groups.InterventionsBefore operation, patients in group D8, D16 and P received dexamethasone 8 mg, dexamethasone 16 mg and placebo (0.9% saline), respectively.Main Outcome MeasuresThe primary outcome was postoperative pain score. Secondary outcomes were opioid consumption, physical parameters of the knees and side effects of dexamethasone.ResultsCompared with placebo, group D16 patients had significantly less pain during maximal active flexion on postoperative day 3 [-1.3 (95% CI, -2.2 to -0.31), P = 0.005]. There was also a significant dose-dependent trend between pain scores and dexamethasone dose (P = 0.002). Compared with placebo, patients in group D16 consumed significantly less opioid [-6.4 mg (95% CI, -11.6 to -1.2), P = 0.025] and had stronger quadriceps power on the first three postoperative days (all P < 0.05). They also had significantly longer walking distance on postoperative day 1 [7.8 m ([95% CI, 0.85 to 14.7), P = 0.023] with less assistance during walking on the first two postoperative days (all P < 0.029) and significantly better quality-of-recovery scores on postoperative day 1 (P = 0.018). There were significant dose-dependent trends between all the above parameters and dexamethasone dose (all P < 0.05). No significant differences were found in the incidence of chronic pain or knee function 3, 6 and 12 months postoperatively.ConclusionDexamethasone 16 mg given before total knee arthroplasty led to a reduction in postoperative pain, less opioid consumption, stronger quadriceps muscle power, better mobilisation and better overall quality-of-recovery after operation. No long-term improvement in reduction in pain and function of the knee was found.Trial RegistrationClinicalTrials.gov identifier: NCT02767882.

15 keywords...

hide…