Lei Yiting, Huang Zeyu, Huang Qiang, Pei Fuxing, Huang Wei
Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People's Republic of China.
Arch Orthop Trauma Surg. 2022 Apr;142(4):665-672. doi: 10.1007/s00402-021-03859-3. Epub 2021 Mar 20.
The optimal dose regimen of dexamethasone in total knee arthroplasty (TKA) has not been determined. This study was performed to evaluate the impact of a single preoperative high-dose dexamethasone compared with two perioperative low-dose dexamethasone in TKA.
We prospectively studied three regimens on dexamethasone: no dexamethasone (A), a single preoperative dose of 20-mg dexamethasone (B), and two perioperative doses of 10-mg dexamethasone (C). The primary outcome was postoperative pain level. The incidence of postoperative nausea and vomiting (PONV), use of analgesic and antiemetic rescue, interleukin-6 (IL-6) and C-reactive protein (CRP) levels, range of motion (ROM), and complications were also compared.
The dynamic pain scores and CRP and IL-6 levels were significantly lower for Group B compared to Groups A and C on postoperative days 1 and 2 (POD 1 and 2). Such differences were also detected between Groups C and A. Besides, the pain scores at rest were significantly lower in Groups B and C than in Group A on POD 1 and 2. Patients in Groups B and C had a lower incidence of PONV, reduced use of analgesic and antiemetic rescue, and improved ROM than in Group A. No complications occurred in any group.
Dexamethasone in TKA provides short-term advantages in analgesic, antiemetic and anti-inflammatory effects. Besides, regarding the effects of pain and inflammatory control on POD 1 and 2, a single preoperative high dose of 20-mg dexamethasone was more effective than two perioperative low doses of 10-mg dexamethasone.
I.
全膝关节置换术（TKA）中地塞米松的最佳剂量方案尚未确定。本研究旨在评估术前单次高剂量地塞米松与TKA术中两次低剂量地塞米松的效果。
我们前瞻性地研究了三种地塞米松给药方案：不给地塞米松（A组）、术前单次给予20毫克地塞米松（B组）和术中两次给予10毫克地塞米松（C组）。主要结局是术后疼痛水平。还比较了术后恶心呕吐（PONV）的发生率、镇痛和止吐补救药物的使用、白细胞介素-6（IL-6）和C反应蛋白（CRP）水平、活动范围（ROM）及并发症。
与A组和C组相比，B组术后第1天和第2天（POD 1和2）的动态疼痛评分以及CRP和IL-6水平显著更低。C组和A组之间也存在此类差异。此外，在POD 1和2时，B组和C组静息时的疼痛评分显著低于A组。B组和C组患者的PONV发生率更低，镇痛和止吐补救药物的使用减少，ROM改善。所有组均未发生并发症。
TKA中地塞米松在镇痛、止吐和抗炎作用方面具有短期优势。此外，就POD 1和2时的疼痛和炎症控制效果而言，术前单次给予20毫克高剂量地塞米松比术中两次给予10毫克低剂量地塞米松更有效。
I级。
