• Cecilie Bauer Derby, Kasper Smidt Gasbjerg, Daniel Hägi-Pedersen, Troels Haxholdt Lunn, Niels Anker Pedersen, Peter Lindholm, Stig Brorson, Henrik Morville Schrøder, Kasper Højgaard Thybo, Jens Bagger, Martin Lindberg-Larsen, Søren Overgaard, Janus Christian Jakobsen, and Ole Mathiesen.
• Centre for Anaesthesiological Research, Department of Anesthesiology, Zealand University Hospital, Køge, Denmark.
• Acta Anaesthesiol Scand. 2024 Jan 1; 68 (1): 354235-42.

ObjectivesThe DEX-2-TKA trial demonstrated that one and two doses of 24 mg intravenous dexamethasone reduced opioid consumption and pain after total knee arthroplasty (TKA). We aimed to investigate the prolonged effects of dexamethasone after the 48-h intervention period.DesignThis was a prospective, pre-planned questionnaire follow-up on postoperative days 3-7 of patients in the DEX-2-TKA trial that randomly received: DX1 (dexamethasone 24 mg + placebo), DX2 (dexamethasone 24 mg + dexamethasone 24 mg), and placebo (placebo + placebo) perioperatively and 24 h later.SettingA multicenter trial performed at five Danish hospitals.ParticipantsWe analyzed 434 of 485 adult participants enrolled in the DEX-2-TKA trial.Outcome MeasuresPrimary outcome was difference between groups in average of all numerical rating scale (NRS) pain scores reported in the morning, at bedtime, and the daily average pain on postoperative days 3-7. Secondary outcomes were sleep quality and patient satisfaction.ResultsThe median (interquartile range) pain intensity levels for postoperative days 3-7 were: DX2 3.2 (2.1-4.3); DX1 3.3 (2.3-4.1); and placebo 3.3 (2.5-4.7). Hodges-Lehmann median differences between groups were: 0 (95% confidence interval - 0.54 to 0.2), P = 0.38 between DX1 and placebo; 0.1 (-0.47 to 0.33), p = .87 between DX1 and DX2; and 0.1 (-0.6 to 0.13), p = .20 between DX2 and placebo. We found no relevant differences between groups on sleep quality on postoperative days 3-7 nor for patient satisfaction with the analgesic treatment.ConclusionsWe found that neither one nor two doses of 24 mg intravenous dexamethasone demonstrated prolonged effects on overall pain or sleep quality on postoperative days 3-7 after total knee arthroplasty. We also found that dexamethasone had no effect on patient satisfaction.Trial Registration NumberClinicaltrials.gov NCT03506789 (main result trial).© 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

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