Department of Anaesthesiology, Hvidovre University Hospital, Kettegård Allé 30, DK-2650 Copenhagen, Denmark.
Br J Anaesth. 2013 Jan;110(1):66-73. doi: 10.1093/bja/aes345. Epub 2012 Sep 17.
High-dose glucocorticoid may reduce postsurgical pain and improve recovery. We hypothesized that 125 mg methylprednisolone (MP) would reduce time to meet functional discharge criteria after total hip arthroplasty (THA).
Forty-eight patients undergoing unilateral THA under spinal anaesthesia were consecutively included in this randomized, double-blind, placebo-controlled trial receiving preoperative i.v. MP or saline. All patients received a standardized, multimodal analgesic regime with paracetamol, celecoxib, and gabapentin. The primary outcome was time to meet well-defined functional discharge criteria. Secondary outcomes were handgrip strength and endurance, pain, nausea, vomiting, fatigue, sleep quality, and rescue analgesic-, antiemetic-, and hypnotic medicine requirements. The inflammatory response measured by C-reactive protein (CRP) and actual length of stay were also registered. Discharge criteria were assessed twice daily (at 09:00 and 14:00 h) until discharge. Other outcomes were assessed at 2, 4, 6, 8, and 24 h after operation, and also in a questionnaire from postoperative day (POD) 1-4.
Time to meet discharge criteria was [median (IQR) (95% CI), MP vs placebo]: 23.5 (23.3-23.7) (17.8-43.8) vs 23.5 (23.0-23.8) (20.0-46.8) h, the mean difference (95% CI) being -1.3 (-4.7 to 2.2) h, P=0.65. Overall pain for the first 24 h after surgery was significantly reduced in the MP vs the placebo group (P<0.01), as was CRP at 24 h (P<0.0001). No other between-group differences were observed. No drug-related complications were observed at follow-up on POD30.
MP 125 mg i.v. before surgery added to a multimodal oral analgesic regime did not reduce time to meet functional discharge criteria after THA, but improved analgesia for the first 24 h.
大剂量糖皮质激素可减轻术后疼痛并促进康复。我们假设 125mg 甲泼尼龙（MP）可缩短全髋关节置换术后达到功能出院标准的时间。
本研究为一项连续入选的、随机的、双盲、安慰剂对照试验，共纳入 48 例行椎管内麻醉下单侧全髋关节置换术的患者，术前分别静脉给予 MP 或生理盐水。所有患者均接受标准化的多模式镇痛方案，包括对乙酰氨基酚、塞来昔布和加巴喷丁。主要结局是达到明确的功能出院标准的时间。次要结局是握力和耐力、疼痛、恶心、呕吐、疲劳、睡眠质量以及需要使用解救镇痛、止吐和催眠药物的情况。还记录了 C 反应蛋白（CRP）测量的炎症反应和实际住院时间。出院标准每天评估两次（09:00 和 14:00 时），直至出院。其他结局在术后 2、4、6、8 和 24 小时以及术后第 1-4 天的问卷调查中进行评估。
达到出院标准的时间[中位数（IQR）（95%CI），MP 与安慰剂]：23.5（23.3-23.7）（17.8-43.8）比 23.5（23.0-23.8）（20.0-46.8）h，平均差值（95%CI）为-1.3（-4.7 至 2.2）h，P=0.65。术后 24 小时内，MP 组的总体疼痛明显低于安慰剂组（P<0.01），24 小时时 CRP 也低于安慰剂组（P<0.0001）。未观察到其他组间差异。在术后 30 天的随访中未观察到与药物相关的并发症。
术前静脉给予 125mg MP 联合口服多模式镇痛方案并未缩短全髋关节置换术后达到功能出院标准的时间，但可改善术后 24 小时内的镇痛效果。
