Department of Orthopaedic Surgery, Japan Community Health Care Organization Gunma Central Hospital, Maebashi, Japan.
Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan.
J Bone Joint Surg Am. 2021 Feb 17;103(4):319-325. doi: 10.2106/JBJS.20.01153.
Corticosteroids are widely used in total knee arthroplasty (TKA) to relieve postoperative pain and prevent postoperative nausea. The aim of this prospective, randomized controlled study was to compare the effects of intravenous and periarticular administration of corticosteroids on pain control, prevention of postoperative nausea, and inflammation and thromboembolism markers following TKA.
One hundred patients undergoing TKA were randomly allocated to either the intravenous administration or periarticular injection group. The intravenous administration group received 10 mg dexamethasone 1 hour before and 24 hours after the surgical procedure, as well as a periarticular injection placebo during the procedure. The periarticular injection group received a 40-mg injection of triamcinolone acetonide during the surgical procedure, as well as an intravenous administration placebo 1 hour before and 24 hours after the procedure. Postoperative pain scores at rest and during walking and nausea scores were recorded according to the 0-to-10 Numerical Rating Scale. Interleukin-6 (IL-6), C-reactive protein (CRP), and prothrombin fragment 1.2 (PF1.2) were measured preoperatively and postoperatively.
Pain scores at rest and during walking 24 hours postoperatively were significantly lower in the periarticular injection group than in the intravenous administration group. Nausea scores showed no significant difference between groups. IL-6 at 24 and 48 hours postoperatively also showed no significant difference between groups. CRP at 24 and 48 hours postoperatively was significantly lower in the intravenous administration group than in the periarticular injection group. In contrast, CRP at 1 week postoperatively was significantly higher in the intravenous administration group than in the periarticular injection group. The mean PF1.2 was significantly lower in the intravenous administration group than in the periarticular injection group at 4 hours postoperatively. Two cases of deep venous thrombosis in each group were detected with use of ultrasonographic examination.
Periarticular injection of corticosteroids showed a better pain-control effect at 24 hours postoperatively than did intravenous administration, whereas the antiemetic effect was similar between treatments. Although intravenous administration had a better anti-thromboembolic effect than periarticular injection, the incidence of deep venous thrombosis was low in both groups.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
皮质类固醇在全膝关节置换术（TKA）中被广泛用于缓解术后疼痛和预防术后恶心。本前瞻性、随机对照研究的目的是比较静脉内和关节周围给予皮质类固醇对 TKA 后疼痛控制、预防术后恶心、炎症和血栓栓塞标志物的影响。
100 例接受 TKA 的患者被随机分配到静脉内给药或关节周围注射组。静脉内给药组在手术前 1 小时和手术后 24 小时内接受 10 毫克地塞米松，以及手术期间关节周围注射安慰剂。关节周围注射组在手术期间接受 40 毫克曲安奈德注射，并在手术前 1 小时和手术后 24 小时内接受静脉内给药安慰剂。根据 0 到 10 的数字评分量表记录术后静息和行走时的疼痛评分以及恶心评分。术前和术后测量白细胞介素-6（IL-6）、C 反应蛋白（CRP）和凝血酶原片段 1.2（PF1.2）。
关节周围注射组患者术后 24 小时静息和行走时的疼痛评分明显低于静脉内给药组。两组间恶心评分无显著差异。术后 24 小时和 48 小时的 IL-6 也无组间差异。术后 24 小时和 48 小时 CRP 静脉内给药组明显低于关节周围注射组。相反，术后 1 周静脉内给药组 CRP 明显高于关节周围注射组。术后 4 小时静脉内给药组 PF1.2 均值明显低于关节周围注射组。每组均通过超声检查检测到 2 例深静脉血栓形成。
关节周围注射皮质类固醇在术后 24 小时的止痛效果优于静脉内给药，而两种治疗方法的止吐效果相似。虽然静脉内给药的抗血栓形成效果优于关节周围注射，但两组深静脉血栓形成的发生率均较低。
治疗水平 I。有关证据水平的完整说明，请参阅作者说明。
