Henry Ford Health System, Detroit, MI, USA.
Henry Ford Health System, Detroit, MI, USA.
J Shoulder Elbow Surg. 2021 Jul;30(7):1544-1552. doi: 10.1016/j.jse.2020.12.005. Epub 2021 Jan 22.
Multimodal pain control can be beneficial in relieving postoperative pain and limiting narcotic use following orthopedic procedures. Additionally, with increasing interest in outpatient arthroplasty procedures, providers have interest in adequate early postoperative pain control and complications. The purpose of this study was to investigate the effect of dexamethasone on pain, postoperative nausea and vomiting, and length of stay following total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA).
One hundred twelve patients undergoing TSA or RTSA by a single surgeon were assessed for inclusion in this investigation. We performed a prospective randomized controlled trial to investigate the effect of 10 mg of dexamethasone administered within 90 minutes of surgery. Primary outcome assessed was the average morphine equivalent use over the first 24 hours postsurgery. Secondary outcomes included postoperative visual analog scale (VAS) scores, antiemetic use, postoperative nausea and vomiting, and complications.
A total of 75 patients were included in the final analysis, with 32 patients (42.7%) randomized to the control group and 43 (57.3%) randomized to the dexamethasone group. Body mass index was significantly greater in the control group (33.8 vs. 30.3, P = .014); otherwise, there were no significant demographic differences between groups. Average ondansetron use was significantly lower in the dexamethasone group compared with controls for the 0- to 4-hour interval (0.1 vs. 0.9 mg, respectively, P = .006) and was lower overall for the first 24 hours (0.3 vs. 1.0 mg, P = .025). Differences in VAS scores were significantly lower in the dexamethasone group at all time points (P < .05 for all). The average VAS score over the 24-hour period for the dexamethasone group was also significantly lower than the controls (3 vs. 6, P < .001). Morphine equivalent use was significantly lower in the dexamethasone group compared with controls at 12-16 hours (1.7 vs. 4.0 mg, respectively, P = .004) and at 16-20 hours (1.7 vs. 3.4 mg, respectively, P = .006). When averaged over the first 24 hours, morphine equivalent was also significantly lower in the dexamethasone group (16.1 vs. 25.4 mg, P = .007). There was no significant difference in glucose control or complications between groups.
Dexamethasone decreases opioid requirements in the first 24 hours following surgery, provides improved pain control, and decreases antiemetic use following shoulder arthroplasty. Dexamethasone is an important multimodal adjunct for controlling pain and postoperative nausea and vomiting following primary TSA.
多模式疼痛控制可有助于缓解骨科手术后的疼痛并限制阿片类药物的使用。此外，随着对门诊关节置换手术的兴趣日益增加，提供者对术后早期充分的疼痛控制和并发症的发生有兴趣。本研究的目的是研究地塞米松对全肩关节置换术（TSA）和反式全肩关节置换术（RTSA）后疼痛、术后恶心和呕吐以及住院时间的影响。
对由一名外科医生进行 TSA 或 RTSA 的 112 例患者进行了评估，以纳入该研究。我们进行了一项前瞻性随机对照试验，以研究手术 90 分钟内给予 10 毫克地塞米松的效果。主要评估指标是术后 24 小时内吗啡等效物的平均使用量。次要结果包括术后视觉模拟评分（VAS）、止吐药使用、术后恶心和呕吐以及并发症。
共有 75 例患者最终纳入分析，其中 32 例（42.7%）患者随机分配至对照组，43 例（57.3%）患者随机分配至地塞米松组。对照组的体重指数明显大于对照组（33.8 对 30.3，P =.014）；否则，两组之间没有明显的人口统计学差异。与对照组相比，地塞米松组在 0-4 小时期间昂丹司琼的平均使用量明显降低（分别为 0.1 对 0.9 毫克，P =.006），在 24 小时内总体上也较低（0.3 对 1.0 毫克，P =.025）。地塞米松组在所有时间点的 VAS 评分均明显低于对照组（所有 P <.05）。地塞米松组在 24 小时期间的平均 VAS 评分也明显低于对照组（3 对 6，P <.001）。与对照组相比，地塞米松组在 12-16 小时（分别为 1.7 对 4.0 毫克，P =.004）和 16-20 小时（分别为 1.7 对 3.4 毫克，P =.006）时的吗啡等效物用量明显较低。当平均到前 24 小时时，地塞米松组的吗啡等效物也明显较低（16.1 对 25.4 毫克，P =.007）。两组之间的血糖控制或并发症无显著差异。
地塞米松可减少术后 24 小时内的阿片类药物需求，提供更好的疼痛控制，并减少肩关节置换术后的止吐药使用。地塞米松是控制原发性 TSA 术后疼痛和术后恶心呕吐的重要多模式辅助药物。
