• Hong Xu, Shaoyun Zhang, Jinwei Xie, Yiting Lei, Guorui Cao, and Fuxing Pei.
• Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
• J Arthroplasty. 2018 Nov 1; 33 (11): 3448-3454.

BackgroundThis study aimed to evaluate the effect and safety of multiple doses of preoperative dexamethasone on pain and recovery after total knee arthroplasty (TKA).MethodsAltogether, 182 patients undergoing TKA received 3 intravenous injections of normal saline (group A), 1 injection of high-dose dexamethasone (20 mg) and 2 injections of normal saline (group B), or 1 injection of high-dose dexamethasone and 2 injections of low-dose (10 mg) dexamethasone (group C).ResultsVisual analog scale was lower in group C than in group A or B and was different between groups A and B on postoperative days 1, 2, and 3 (all P < .05). Fewer group C patients required analgesic rescue and had lower total analgesic than those in group A or B, with the same difference between groups A and B (all P < .05). C-reactive protein and interleukin-6 levels were lower in groups B and C than in group A at 24, 48, and 72 hours postoperatively. C-reactive protein at 72 hours and interleukin-6 at 48 and 72 hours were lower in group C than in group B (all P < .05). Incidences of postoperative nausea and vomiting, number of patients requiring antiemetic rescue, and overall consumption of metoclopramide were lower in groups B and C than in group A (all P < .05). No surgical-site infections or gastrointestinal hemorrhages were detected in any group.ConclusionMultiple dexamethasone doses further reduced postoperative pain, decreased consumption of analgesic drugs, and provided more powered inflammation control. These findings call for further studies to further evaluate its safety.Copyright © 2018 Elsevier Inc. All rights reserved.

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