Department of Joint Surgery and Sports Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Eur Rev Med Pharmacol Sci. 2023 Apr;27(8):3438-3447. doi: 10.26355/eurrev_202304_32114.
This study aimed to evaluate the efficacy of different dexamethasone doses in the perioperative period of total hip arthroplasty (THA).
We randomly divided 180 patients into three groups: three perioperative saline injections (Group A, placebo); two perioperative doses of 15 mg dexamethasone plus a postoperative saline injection at 48 h (Group B); and three perioperative doses of dexamethasone (10 mg) (Group C). Primary outcomes were postoperative pain at rest and while walking. We also recorded consumption of analgesics and antiemetics, incidence of postoperative nausea and vomiting (PONV), C-reactive protein (CRP) and interleukin-6 (IL-6) levels, postoperative length of stay (p-LOS), range of motion (ROM), nausea, Identity-Consequence-Fatigue-Scale (ICFS), and severe complications (e.g., incidence of surgical site infection, SSI and gastrointestinal bleeding, GIB).
Group B and C had significantly lower pain scores at rest than Group A on postoperative day 1. Group B and C also had significantly lower dynamic pain score, CRP, and IL-6 than Group A on postoperative day 1, 2, and 3. Patients in Group B and C had lower PONV incidence, reduced use of analgesics and antiemetics, improved ROM, shorter p-LOS, lower VAS nausea score, and lower ICFS than Group A patients. On postoperative day 3, patients in Group C had significantly lower dynamic pain and ICFS scores, IL-6, and CRP than Group B patients, as well as higher ROM. None of the groups exhibited SSI or GIB.
Dexamethasone provides short-term advantages in reducing pain, PONV, inflammation, and ICFS, and increasing ROM in the early postoperative period after THA. Dexamethasone efficacy in reducing post-THA pain, inflammation, and PONV at 10 mg and 15 mg is similar during the first 48 h. Dexamethasone (30 mg) divided into three 10 mg doses was superior to two doses (15 mg) in reducing pain, inflammation, and ICFS, as well as in increasing ROM on postoperative day 3.
本研究旨在评估全髋关节置换术（THA）围手术期不同地塞米松剂量的疗效。
我们将 180 名患者随机分为三组：三组围手术期生理盐水注射（A 组，安慰剂）；两组围手术期 15mg 地塞米松加术后 48 小时生理盐水注射（B 组）；三组围手术期 3 次地塞米松（10mg）（C 组）。主要结局是术后静息和行走时的疼痛。我们还记录了镇痛药和止吐药的消耗、术后恶心和呕吐（PONV）的发生率、C 反应蛋白（CRP）和白细胞介素 6（IL-6）水平、术后住院时间（p-LOS）、关节活动度（ROM）、恶心、身份-后果-疲劳量表（ICFS）和严重并发症（如手术部位感染（SSI）和胃肠道出血（GIB）的发生率）。
B 组和 C 组在术后第 1 天静息时的疼痛评分明显低于 A 组。B 组和 C 组在术后第 1、2 和 3 天的动态疼痛评分、CRP 和 IL-6 也明显低于 A 组。B 组和 C 组患者的 PONV 发生率较低，镇痛药和止吐药的使用减少，ROM 改善，p-LOS 缩短，VAS 恶心评分降低，ICFS 降低。在术后第 3 天，C 组患者的动态疼痛和 ICFS 评分、IL-6 和 CRP 明显低于 B 组，ROM 更高。三组均未出现 SSI 或 GIB。
地塞米松在减轻 THA 后早期疼痛、PONV、炎症和 ICFS 方面具有短期优势，并增加术后早期的 ROM。在最初的 48 小时内，10mg 和 15mg 地塞米松在减轻术后 THA 疼痛、炎症和 PONV 方面的疗效相似。将 30mg 地塞米松分为 3 次 10mg 剂量，在术后第 3 天减轻疼痛、炎症和 ICFS 方面优于两次 15mg 剂量，增加 ROM。
