Department of Orthopedic Surgery, Hanil General Hospital, Seoul, South Korea.
Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
J Arthroplasty. 2020 Jan;35(1):69-75. doi: 10.1016/j.arth.2019.08.026. Epub 2019 Aug 19.
Systemic steroid has been used to control pain and nausea in total knee arthroplasty (TKA), but most studies recommend a single dose administration prior to, or during, surgery. This study aimed to determine the efficacy of administration on 1 day postoperatively.
Patients who were scheduled to undergo TKA were randomly assigned to the following groups: control group, receiving normal saline injection; group 1, receiving 10 mg dexamethasone intravenously (IV) 1 hour before surgery; group 2, receiving 0.1 mg/kg dexamethasone (IV) 24 hours after surgery; or group 3, receiving 0.2 mg/kg dexamethasone (IV) 24 hours after surgery (n = 44-46 per group). Primary outcomes were pain and nausea visual analogue scale (VAS). Secondary outcomes were analgesic administration, rescue antiemetic administration, C-reactive protein, range of motion, and complications.
Postoperative pain and nausea remained high for 48 hours post-TKA. Group 1 had lower pain and nausea VAS scores than did the control group (P < .01) for only 24 hours post-TKA. Groups 2 and 3 had lower pain and nausea VAS scores than did the control group and group 1 (P < .01) 48 hours post-TKA. Analgesic and antiemetic administration were significantly lower in groups 2 and 3 than in the control group during 48 hours after TKA. There were no differences in C-reactive protein level and range of motion, and complications were not detected.
The effect of preoperative and postoperative administration of dexamethasone for controlling pain and nausea was observed only for 24 hours. Considering that severe pain and nausea persisted for more than 48 hours after TKA, additional administration of dexamethasone at 1 day postoperatively is suggested.
Level I.
在全膝关节置换术（TKA）中，全身性类固醇已被用于控制疼痛和恶心，但大多数研究建议在手术前或手术期间给予单次剂量。本研究旨在确定术后第 1 天给药的疗效。
计划接受 TKA 的患者被随机分配到以下组：对照组，接受生理盐水注射；组 1，手术前 1 小时静脉注射 10mg 地塞米松；组 2，手术后 24 小时静脉注射 0.1mg/kg 地塞米松；或组 3，手术后 24 小时静脉注射 0.2mg/kg 地塞米松（每组 44-46 例）。主要结局是疼痛和恶心视觉模拟量表（VAS）。次要结局是镇痛药物的使用、止吐药物的使用、C 反应蛋白、活动范围和并发症。
TKA 后 48 小时内，术后疼痛和恶心持续存在。与对照组相比，组 1 在 TKA 后 24 小时内的疼痛和恶心 VAS 评分较低（P <.01）。与对照组和组 1 相比，组 2 和组 3 在 TKA 后 48 小时内的疼痛和恶心 VAS 评分较低（P <.01）。在 TKA 后 48 小时内，组 2 和组 3 的镇痛和止吐药物的使用明显低于对照组。C 反应蛋白水平和活动范围无差异，且未发现并发症。
术前和术后给予地塞米松控制疼痛和恶心的效果仅持续 24 小时。考虑到 TKA 后超过 48 小时仍存在严重疼痛和恶心，建议在术后第 1 天额外给予地塞米松。
I 级。
