High dose dexamethasone in high pain responders undergoing total hip arthroplasty: A randomized controlled trial.
Eur J Anaesthesiol
; 40(10): 737-746, 2023 10 01.
Article
em En
| MEDLINE
| ID: mdl-37166257
ABSTRACT
BACKGROUND:
Postoperative pain after total hip arthroplasty (THA) may delay postoperative mobilization and discharge. Postoperative pain has been shown to be higher in pain catastrophisers and patients receiving opioids. A single dose of glucocorticoid reduces pain after THA, and an increased dose of glucocorticoids has been found to be effective in patients at high risk of postoperative pain after total knee arthroplasty (TKA), however, the ideal dose in THA remains unknown.OBJECTIVE:
To evaluate the effect of a high dose (1âmgâkg -1 ) vs. intermediate dose (0.3âmgâkg -1 ) of dexamethasone on pain after THA.DESIGN:
A randomized double-blind controlled study.SETTING:
A two-centre study including two large arthroplasty sites in Denmark was conducted from February 2019 to August 2020. PATIENTS A total of 160 patients undergoing THA by neuraxial block with multimodal analgesia, having a Pain Catastrophising Scale score >20âand/or preoperative opioid use were included. INTERVENTION Patients were randomly assigned to receive dexamethasone 1âmgâkg -1 or 0.3âmgâkg -1 before THA. MAIN OUTCOMEMEASURES:
Primary outcome was percentage of patients experiencing moderate to severe pain (visual analogue scale, VAS > 30âmm on a 0 to 100âmm scale) on ambulating 24âh after surgery. Secondary outcomes included cumulated pain scores, C-reactive protein (CRP), opioid use, postoperative recovery scores, length of stay, complications, and re-admission within 30 and 90 days.RESULTS:
No difference was found in percentage of VAS >30âmm 24âh after surgery in the 5-m walk test (VAS > 30/VAS ≤ 30%); 33/42 (44%) vs. 32/43 (43%), relative riskâ=â1.04 (95% confidence interval 0.72-1.51; P â=â0.814) in 1âmgâkg -1vs. 0.3âmgâkg -1 respectively. No differences were found in CRP and opioid use between groups. Also, no intergroup differences were found in recovery scores, re-admissions, or complications.CONCLUSION:
1âmgâkg -1vs. 0.3âmgâkg -1 dexamethasone improved neither postoperative pain nor recovery in THA in a cohort of predicted high pain responders. TRIAL REGISTRATION ClinicalTrials.gov ID-number NCT03763760 and EudraCT-number 2018-2636-25.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Artroplastia de Quadril
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article