Qin Kai, Sun Xiangxiang, Dou Qunli, Li Bowei, Bai Guoyang, Sun Xiaobo, Ma Jianbing, Xu Chao, Huang Yuanchi
Department of Knee Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, China.
Front Med (Lausanne). 2025 Jul 9;12:1575417. doi: 10.3389/fmed.2025.1575417. eCollection 2025.
Corticosteroids such as dexamethasone and betamethasone are widely used for local infiltration analgesia in total knee arthroplasty (TKA). However, the analgesic efficacy of these two glucocorticoids in TKA cocktail therapy remains unknown. Therefore, this study aims to compare the analgesic efficacy and safety of betamethasone and dexamethasone in TKA through a prospective randomized controlled trial (RCT).
A total of 120 patients were randomly assigned to three groups: Control (Con) group, Dexamethasone (Dex) group and Betamethasone (Beta) group. The primary outcome was the postoperative visual analog scale (VAS); the secondary outcomes were the knee range of motion (ROM).
Compared with the Con group, the VAS scores of the Dex group during walking were decreased significantly at 12 and 24 h postoperatively, while the Beta group showed a decrease at 12, 24, 48 h and 2 weeks postoperatively. In terms of dynamic VAS scores at 12, 24, 48 h and 2 weeks postoperatively the Beta group was superior to the Dex group. At 48 h and 2 weeks postoperatively, the ROM in the Beta group was better than Dex group. There were no significant differences among the three groups in terms of inflammatory markers and incidence of postoperative adverse event.
Our prospective RCT demonstrates that betamethasone exhibits better analgesic effects than dexamethasone in the cocktail therapy of TKA and does not incur additional complications, providing a medication basis for the local application of glucocorticoids in TKA.
https://www.chictr.org.cn, identifier ChiCTR2300072533.
地塞米松和倍他米松等皮质类固醇广泛用于全膝关节置换术（TKA）的局部浸润镇痛。然而，这两种糖皮质激素在TKA鸡尾酒疗法中的镇痛效果尚不清楚。因此，本研究旨在通过前瞻性随机对照试验（RCT）比较倍他米松和地塞米松在TKA中的镇痛效果和安全性。
总共120例患者被随机分为三组：对照组（Con）、地塞米松（Dex）组和倍他米松（Beta）组。主要结局是术后视觉模拟量表（VAS）；次要结局是膝关节活动范围（ROM）。
与Con组相比，Dex组术后12小时和24小时行走时的VAS评分显著降低，而Beta组在术后12、24、48小时和2周时降低。在术后12、24、48小时和2周的动态VAS评分方面，Beta组优于Dex组。术后48小时和2周时，Beta组的ROM优于Dex组。三组在炎症标志物和术后不良事件发生率方面无显著差异。
我们的前瞻性RCT表明，在TKA鸡尾酒疗法中，倍他米松比地塞米松具有更好的镇痛效果，且不会引发额外并发症，为糖皮质激素在TKA中的局部应用提供了用药依据。
