Orthopedic Center, Nanjing Jiangbei Hospital, Nanjing, 210043, Jiangsu, People's Republic of China.
Department of Orthopedics Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, Anhui, People's Republic of China.
J Orthop Surg Res. 2023 Sep 22;18(1):715. doi: 10.1186/s13018-023-04164-y.
A randomized controlled double-blind trial was conducted to evaluate the effects of adding dexamethasone to the local infiltration analgesia (LIA) mixture on frequency of patient controlled analgesia (PCA) and opioids consumption after simultaneous bilateral total hip or knee arthroplasty (THA or TKA).
108 patients who received simultaneous bilateral THA or TKA were randomly divided into dexamethasone group and normal saline (NS) group. The main difference between two groups was whether or not dexamethasone was added to the LIA mixture. The main outcome was the cumulative consumption of opioids within 24 h. The secondary outcome were the total cumulative consumption of opioids during postoperative hospitalization, consumption of opioids drug for rescue analgesia, frequency of PCA, postoperative Visual Analogue Scale (VAS), and complications.
Cumulative consumption of opioids in the 24 h was similar between two groups (P = 0.17). Total cumulative consumption of opioids in the dexamethasone group during postoperative hospitalization was significantly lower (P = 0.03). No significant difference in the consumption of opioids drug for rescue analgesia between two groups within 24 h, while the frequency of PCA was significantly different (P = 0.04). VAS of dexamethasone group and NS group were similar during postoperative hospitalization, while the incidence of postoperative nausea and vomiting (PONV) in dexamethasone group was lower than that in NS group.
Adding dexamethasone to LIA in the simultaneous bilateral THA or TKA can effectively reduce the total cumulative consumption of opioids and the frequency of PCA, as well as reduce the incidence of PONV. Trial Registration The trial has been registered in the Chinese Clinical Trial Registry (Registration Number: ChiCTR2100042551, Date: 23/01/2021).
一项随机对照双盲试验评估了在局部浸润镇痛（LIA）混合物中加入地塞米松对同期双侧全髋关节或膝关节置换术后（THA 或 TKA）患者自控镇痛（PCA）和阿片类药物消耗频率的影响。
108 例接受同期双侧 THA 或 TKA 的患者随机分为地塞米松组和生理盐水（NS）组。两组的主要区别在于 LIA 混合物中是否添加地塞米松。主要结果是 24 小时内阿片类药物的累积消耗量。次要结果是术后住院期间阿片类药物的总累积消耗量、解救镇痛用阿片类药物的消耗量、PCA 频率、术后视觉模拟评分（VAS）和并发症。
两组 24 小时内阿片类药物的累积消耗量相似（P=0.17）。地塞米松组术后住院期间阿片类药物的总累积消耗量明显较低（P=0.03）。两组在 24 小时内解救镇痛用阿片类药物的消耗量无显著差异，而 PCA 的频率则有显著差异（P=0.04）。两组术后住院期间 VAS 相似，而地塞米松组术后恶心呕吐（PONV）的发生率低于 NS 组。
在同期双侧 THA 或 TKA 中，LIA 中加入地塞米松可有效减少阿片类药物的总累积消耗量和 PCA 的频率，并降低 PONV 的发生率。
该试验已在中国临床试验注册中心注册（注册号：ChiCTR2100042551，日期：2021 年 1 月 23 日）。
