Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, Korea.
Clin Orthop Relat Res. 2013 Sep;471(9):3010-20. doi: 10.1007/s11999-013-3032-5. Epub 2013 May 4.
Dexamethasone is a potent analgesic and antiemetic. However, the benefit of dexamethasone after TKA is unclear, as is the efficacy in a current multimodal regime.
QUESTIONS/PURPOSES: We determined (1) whether the addition of dexamethasone to a protocol including ramosetron further reduces postoperative emesis compared with ramosetron alone; (2) whether it reduces postoperative pain; and (3) whether it increases the risk for wound complications in a current multimodal regime after TKA.
We randomized 269 patients undergoing TKAs to receive dexamethasone (10 mg) 1 hour before surgery and ramosetron immediately after surgery (Dexa-Ra group, n = 135), or ramosetron alone (Ra group, n = 134). We recorded the incidence of postoperative nausea and vomiting (PONV), severity of nausea, incidence of antiemetic requirement, complete response, pain level, and opioid consumption. Patients were assessed 0 to 6, 6 to 24, 24 to 48, and 48 to 72 hours postoperatively. In addition, patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery.
The Dexa-Ra group had a lower incidence of PONV during the entire 72-hour evaluation period and experienced less severe nausea for the first 6 hours after TKA, although not between 6 to 72 hours. Overall use of a rescue antiemetic was less frequent, and complete response was more frequent in the Dexa-Ra group. Patients in the Dexa-Ra group experienced lower pain and consumed less opioids during the 6- to 24-hour period and during the overall study period. No differences were found in wound complications between the groups, and each group had one case of periprosthetic joint infection.
Patients who received prophylactic dexamethasone in addition to ramosetron had reduced postoperative emesis and pain without increased risks for wound complications, compared with patients who received ramosetron alone in patients managed using a multimodal regimen after TKA.
地塞米松是一种有效的镇痛和止吐药。然而，TKA 后地塞米松的益处尚不清楚，在当前的多模式治疗方案中也是如此。
问题/目的：我们确定了（1）与单独使用雷莫司琼相比，在包括雷莫司琼的方案中添加地塞米松是否进一步减少术后呕吐；（2）它是否减轻术后疼痛；以及（3）在当前的多模式治疗方案后，TKA 后是否增加伤口并发症的风险。
我们将 269 名接受 TKA 的患者随机分为两组，一组在手术前 1 小时接受地塞米松（10mg）和手术后立即接受雷莫司琼（地塞米松-雷莫司琼组，n=135），另一组仅接受雷莫司琼（雷莫司琼组，n=134）。我们记录了术后恶心和呕吐（PONV）的发生率、恶心的严重程度、止吐药需求的发生率、完全缓解、疼痛程度和阿片类药物的消耗。患者在术后 0 至 6 小时、6 至 24 小时、24 至 48 小时和 48 至 72 小时进行评估。此外，患者在手术后至少 1 年时评估伤口并发症和假体周围关节感染。
地塞米松-雷莫司琼组在整个 72 小时评估期间 PONV 的发生率较低，并且在 TKA 后前 6 小时内恶心程度较轻，尽管在 6 至 72 小时之间没有差异。总体而言，地塞米松-雷莫司琼组使用解救性止吐药的频率较低，完全缓解的频率较高。地塞米松-雷莫司琼组患者在 6 至 24 小时和整个研究期间疼痛程度较低，阿片类药物消耗较少。两组之间在伤口并发症方面没有差异，每组各有一例假体周围关节感染。
与单独使用雷莫司琼的患者相比，在接受 TKA 后多模式治疗方案中接受预防性地塞米松加雷莫司琼治疗的患者，术后呕吐和疼痛减少，而伤口并发症的风险没有增加。
