Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Department of Orthopedic Surgery, NYU Langone Health, Mineola, New York.
J Arthroplasty. 2023 Jul;38(7 Suppl 2):S21-S28. doi: 10.1016/j.arth.2023.02.007. Epub 2023 Feb 10.
The optimal administration of dexamethasone for postoperative pain management and recovery following primary elective total joint arthroplasty (TJA) remains unclear. This study aimed to evaluate the effect of a second intravenous (IV) dose of dexamethasone on postoperative pain scores, inpatient opioid consumption, and functional recovery after total hip arthroplasty (THA) and total knee arthroplasty (TKA).
A retrospective review was conducted of 2,256 primary elective THAs and 1,951 primary elective TKAs between May 2020 and April 2021. Patients who received 2 perioperative doses (2D) of dexamethasone 10 mg IV were propensity-matched 1:1 to a control group who received 1 perioperative dose (1D). Primary outcomes were opiate consumption as morphine milligram equivalences (MMEs), postoperative pain as Verbal Rating Scale (VRS) pain scores, and functional status assessed by the Activity Measure for Post-Acute Care (AM-PAC) scores.
The 2D THA and 2D TKA cohorts consumed significantly less opiates at the 24 to 48-hour and 48 to 72-hour intervals. The 2D TKA cohort had significantly lower total opiate consumption compared to the 1D TKA cohort. Compared to the 1D cohorts, the 2D THA cohort and 2D TKA cohorts had significantly lower pain scores at the 48 to 60-hour interval; additionally, the 2D TKA cohort had significantly lower pain scores in the 36 to 48-hour interval. AM-PAC scores did not differ between cohorts for both TKA and THA at any interval.
The administration of a second perioperative dexamethasone dose significantly decreased opioid consumption in the immediate postoperative period. Inpatient opioid administration can be significantly reduced while maintaining comparable functional recovery and superior pain control.
Retrospective Cohort Study.
在初次择期全关节置换术（TJA）后用于管理术后疼痛和恢复的地塞米松最佳给药方案仍不清楚。本研究旨在评估全髋关节置换术（THA）和全膝关节置换术（TKA）后再次静脉（IV）给予地塞米松 10mg 对术后疼痛评分、住院内阿片类药物消耗和功能恢复的影响。
对 2020 年 5 月至 2021 年 4 月间 2256 例初次择期 THA 和 1951 例初次择期 TKA 患者进行回顾性分析。接受 2 剂（2D）地塞米松 10mg IV 治疗的患者与接受 1 剂（1D）地塞米松的对照组进行倾向匹配（1:1）。主要结局是阿片类药物消耗（吗啡毫克当量（MME））、术后疼痛（VRS 疼痛评分）和术后活动评估量表（AM-PAC）评估的功能状态。
2D THA 和 2D TKA 组在 24-48 小时和 48-72 小时时阿片类药物消耗明显减少。2D TKA 组与 1D TKA 组相比，总阿片类药物消耗明显减少。与 1D 组相比，2D THA 组和 2D TKA 组在 48-60 小时时疼痛评分明显降低；此外，2D TKA 组在 36-48 小时时疼痛评分明显降低。在任何时间段，2D THA 组和 2D TKA 组的 AM-PAC 评分在 TKA 和 THA 两组之间均无差异。
再次给予围手术期地塞米松可显著减少术后即刻阿片类药物的消耗。在保持类似功能恢复和更优疼痛控制的同时，可显著减少住院内阿片类药物的使用。
回顾性队列研究。
