Department of Orthopaedics surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
J Arthroplasty. 2021 May;36(5):1599-1606. doi: 10.1016/j.arth.2020.11.019. Epub 2020 Nov 17.
The optimal route for dexamethasone (DEX) administration regimen for patients undergoing primary TKA has not been investigated. This study aims to determine whether intravenous and topical DEX provide different clinical effects in patients with TKA.
In this double-blinded, placebo-controlled trial, 90 patients undergoing primary TKA were randomized to intravenous DEX group (n = 45) or topical DEX group (n = 45, DEX applied in anesthetic cocktail for periarticular injection). The primary outcome was postoperative VAS pain score and morphine consumption. Secondary outcomes were included knee swelling, knee flexion, and extension angle, Knee Society Score (KSS), and postoperative hospital stays. Tertiary outcomes assessed the blood-related metrics, including inflammatory biomarkers and fibrinolysis parameters. Finally, nausea and vomiting and other adverse events were compared.
The topical administration of DEX provide lower pain score at 2h, 8h, 12h at rest (P < .05) and 12h, 24h with activity (P < .05), and less knee swelling in the first postoperative day (P < .05), while intravenous DEX was more effective in decreasing blood inflammatory biomarkers, including C-reactive protein (CRP) at postoperative 24h (P < .05) and interleukin-6 (IL-6) at postoperative 24h, 48h (P < .05), and reducing postoperative nausea (P < .05) for patients receiving TKA. However, there was no significant difference in knee flexion and extension angle, KSS, postoperative hospital stays, and complications occurrence (P > .05) between intravenous and topical DEX after TKA.
Topical administration of DEX provided better clinical outcomes on postoperative pain management and knee swelling early after TKA, while intravenous DEX was more effective in decreasing blood inflammatory biomarkers and preventing postoperative nausea.
接受初次全膝关节置换术（TKA）的患者中，地塞米松（DEX）给药方案的最佳途径尚未得到研究。本研究旨在确定静脉内和局部 DEX 在 TKA 患者中是否提供不同的临床效果。
在这项双盲、安慰剂对照试验中，90 例接受初次 TKA 的患者被随机分为静脉内 DEX 组（n=45）或局部 DEX 组（n=45，DEX 应用于关节周围注射的麻醉鸡尾酒中）。主要结局是术后 VAS 疼痛评分和吗啡消耗量。次要结局包括膝关节肿胀、膝关节屈曲和伸展角度、膝关节学会评分（KSS）和术后住院时间。三级结局评估血液相关指标，包括炎症生物标志物和纤溶参数。最后，比较了恶心和呕吐等不良反应。
局部 DEX 给药在术后 2h、8h、12h 静息时（P<0.05）和 12h、24h 活动时（P<0.05）疼痛评分较低，且术后第 1 天膝关节肿胀程度较轻（P<0.05），而静脉内 DEX 更有效地降低术后 24h 的血液炎症生物标志物，包括 C 反应蛋白（CRP）（P<0.05）和术后 24h、48h 的白细胞介素-6（IL-6）（P<0.05），并减少接受 TKA 的患者术后恶心（P<0.05）。然而，静脉内和局部 DEX 后 TKA 患者的膝关节屈曲和伸展角度、KSS、术后住院时间和并发症发生率（P>0.05）无显著差异。
局部 DEX 给药在 TKA 后早期的术后疼痛管理和膝关节肿胀方面提供了更好的临床效果，而静脉内 DEX 在降低血液炎症标志物和预防术后恶心方面更有效。
