Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
Department of Anaesthesiology & Pain Medicine, University of Washington, Seattle, Washington.
JBJS Rev. 2024 Sep 16;12(9). doi: e24.00107. eCollection 2024 Sep 1.
» Perioperative corticosteroids are strongly recommended for reducing the incidence and severity of postoperative nausea and vomiting following elective total hip or total knee arthroplasty.» Corticosteroids may reduce postoperative pain and opioid requirements. Similarly, corticosteroids appear to have a neutral-to-positive effect on length of stay, venous thromboembolism, mobility, delirium, acute kidney injury, and bone cement implantation syndrome (i.e., decreased length of stay).» Perioperative corticosteroids may induce hyperglycemia among both diabetic and nondiabetic patients; however, there is no strong evidence indicating that these transient corticosteroid-induced glycemic derangements may increase the risk of postoperative infectious complications.» The dosage and frequency of perioperative corticosteroid administration play a critical role in optimizing postoperative outcomes, with higher doses showing promise in reducing opioid consumption, postoperative pain, and length of stay.» The optimal dosage and frequency of corticosteroids remain unclear; however, the perioperative administration of 8 to 16 mg dexamethasone, or equivalent steroid, appears reasonable and safe in most cases.
» 围手术期皮质类固醇强烈推荐用于降低择期全髋关节或全膝关节置换术后恶心和呕吐的发生率和严重程度。» 皮质类固醇可能会减少术后疼痛和阿片类药物的需求。同样，皮质类固醇似乎对住院时间、静脉血栓栓塞、活动能力、谵妄、急性肾损伤和骨水泥植入综合征（即缩短住院时间）有中性至阳性的影响。» 围手术期皮质类固醇可能会导致糖尿病和非糖尿病患者的血糖升高；然而，没有强有力的证据表明这些短暂的皮质类固醇引起的血糖紊乱会增加术后感染并发症的风险。» 围手术期皮质类固醇的剂量和频率在优化术后结果方面起着关键作用，较高剂量显示出减少阿片类药物消耗、术后疼痛和住院时间的潜力。» 皮质类固醇的最佳剂量和频率仍不清楚；然而，在大多数情况下，围手术期给予 8 至 16 毫克地塞米松或等效类固醇似乎是合理和安全的。
