Wier Julian, Liu Kevin C, Mayfield Cory K, Lin Eric H, Feingold Cailan L, Weber Alexander E, Gamradt Seth C, Liu Joseph N, Petrigliano Frank A
Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, CA, USA.
JSES Rev Rep Tech. 2025 May 6;5(3):376-381. doi: 10.1016/j.xrrt.2025.04.004. eCollection 2025 Aug.
Multimodal approaches to address postoperative pain after total shoulder arthroplasty (TSA) are becoming the standard of care. The combined use of dexamethasone and liposomal bupivacaine (LB) may be an effective method to enhance analgesia. We assess if the addition of dexamethasone to TSA patients receiving LB results in reduced opiate needs and shorter length of stay.
The Premier Healthcare Database was queried from January 1, 2016, to December 31, 2020, for patients who underwent primary, elective anatomic/reverse TSA and received local infiltration LB. Patients were then propensity matched on the probability of receiving dexamethasone. After matching, multivariable models, including all other available multimodal analgesic medications, were generated to evaluate the association between dexamethasone and morphine milligram equivalent intake and length of stay.
A total of 3445 patients remained in each group after matching and were well balanced for covariates (standardized mean difference <0.1). A significant difference in total opioid consumption was observed between groups (median = 36.6 mg vs. 42.5 mg, < .001), with a significant negative correlation between morphine milligram equivalents used and dexamethasone exposure for total opioid use (β = -4.61, 95% confidence interval [CI] = -8.60 to -0.62), postoperative days 1 (β = -2.51, 95% CI = -3.40 to -1.66) and 2 (β = -2.09, 95% CI = -3.86 to -0.32). The adjusted odds of a length of stay beyond 1 day were significantly lower in the dexamethasone-treated group (adjusted odds ratio = 0.64, 95% CI = 0.56-0.73).
Dexamethasone reduces postoperative narcotic use after TSA and reduces length of stay. With increasing pressures to reduce opiate use, these data highlight alternative medication combinations, which may be used to promote this goal.
采用多模式方法处理全肩关节置换术（TSA）后的术后疼痛正成为护理标准。地塞米松与脂质体布比卡因（LB）联合使用可能是增强镇痛效果的有效方法。我们评估在接受LB的TSA患者中添加地塞米松是否会减少阿片类药物的需求并缩短住院时间。
查询2016年1月1日至2020年12月31日的Premier医疗数据库，查找接受初次择期解剖型/反向TSA并接受局部浸润LB的患者。然后根据接受地塞米松的概率对患者进行倾向匹配。匹配后，生成包括所有其他可用多模式镇痛药物的多变量模型，以评估地塞米松与吗啡毫克当量摄入量和住院时间之间的关联。
匹配后每组共有3445名患者，协变量平衡良好（标准化均值差异<0.1）。两组之间观察到总阿片类药物消耗量存在显著差异（中位数=36.6毫克对42.5毫克，<0.001），使用的吗啡毫克当量与地塞米松暴露量之间存在显著负相关，用于总阿片类药物使用（β=-4.61，95%置信区间[CI]=-8.60至-0.62），术后第1天（β=-2.51，95%CI=-3.40至-1.66）和第2天（β=-2.09，95%CI=-3.86至-0.32）。地塞米松治疗组住院时间超过1天的调整后几率显著降低（调整后比值比=0.64，95%CI=0.56-0.73）。
地塞米松可减少TSA术后的麻醉药物使用并缩短住院时间。随着减少阿片类药物使用的压力不断增加，这些数据突出了可用于促进这一目标的替代药物组合。
