ORTHOPOD EDITOR
Jeffrey P. Beckenbaugh, DO

Departments

HOME

PRESIDENT'S MESSAGE

EXECUTIVE DIRECTOR'S MESSAGE

FROM THE EDITOR


In This Edition

Abstract:
Peri-operative Dexamethasone for Control of Pain After Total Knee Arthroplasty

Indirect reduction and fixation of a Lateral Plateau depression fracture utilizing balloon tibioplasty in a cachectic, malnourished patient: A Case Report

Please Join Us at the Postgraduate Seminar

2012 Annual Meeting Recap

Changes Coming to the 2013 Annual Meeting

AOA Develops New Platform for Posting CME Credits for 2013-2015 Cycle

New FDA Ruling Prompts Added CME Option for Providers

Physician Payment Sunshine Act: Final Rule

Good Samaritan Regional Medical Center Orthopedic Surgery Residency Program in its Third Year

We Need More Doctors in Government - How About You?

SAOAO Report:
Student AOAO - A Glance at the Past and a Spotlight on the Future

RAOAO Report

Member Spotlight: Steven J. Heithoff, DO, FAOAO


Thank you to our preliminary exhibitors and supporters

Gold Level
DePuy Orthopaedics

Silver Level
Auxilium Pharmaceuticals
DJO GLOBAL
Innomed, Inc.
Smith & Nephew

Bronze Level
Biomet Orthopaedics

Exhibitors
American Osteopathic Board of Orthopedic Surgery
Auxilium Pharmaceuticals
BioMarin Pharmaceutical Inc.
Biomet Orthopaedics
BioPro, Inc
Bioventus
CeramTec
ConforMIS, Inc.
DePuy Orthopaedics
DJO GLOBAL
Elsevier USA
Exactech
Innomed, Inc.
Lippincott, Williams & Wilkins
Skeletal Dynamics
Smith & Nephew
The Progressive Orthopaedic Company
TranS1
Viztek
Wright Medical Technology, Inc.

Commercial Support
AOAO would like to thank the following companies for providing an educational grant:

DePuy Synthes USA

For the up-to-date list of exhibitors and products descriptions, click here.

Peri-operative Dexamethasone for Control of Pain After Total Knee Arthroplasty

Authors:  AS Rosen, P Pulido, M Munro, S Daneshvari, SN Copp
Scripps Clinic, Shiley Center for Orthopedic Research and Education, La Jolla CA

Introduction 
Pain control following total knee arthroplasty (TKA) still continues to be a problem for many patients.  Narcotics, which are commonly used for pain control, carry nausea and vomiting as potential side effects.  Corticosteroids have been used to decrease pain, inflammation and postoperative nausea and vomiting (PONV).  We hypothesized that dexamethasone given perioperatively to patients undergoing TKA would decrease pain, PONV and increase rehabilitation efforts.

Methods  
We conducted a retrospective chart review of patients identified from our outcomes database who underwent TKA.  The control group was a consecutive series of patients from 2005-2006.  The study group consisted of patients from 2007 when we began using dexamethasone perioperatively.  Twenty-three patients (dexamethasone group) received 10mg dexamethasone intravenously during TKA surgery and dexamethasone 4mg orally daily for three days postoperatively.  The control group did not receive dexamethasone at any time.

We compared opioid, pain scores and PONV for each group.  Ambulation distance on the day of discharge was evaluated as well as any post-operative infections.

Results
No significant differences were noted between groups with regard to age, gender, weight, height or anesthesia.  Patients given dexamethasone spent less time in the PACU (97 min vs 135 min).  Postoperative pain scores in the PACU were less for the dexamethasone group (2.6 vs 4.3).  PACU opioid DE was significantly less in the dexamethasone group (0.419 vs 0.768).  Mean ambulation distance on the day of discharge was 279 feet in the dexamethasone group versus 184 feet in the control group.  No deep infections were seen in either group.

Discussion
We evaluated dexamethasone as a way to decrease pain, PONV, and increase physical functioning following TKA.  In our pilot study we saw lower NRS pain scores (p=0.049) and lower DE usage (p=0.041) in the PACU for the dexamethasone group.  We also saw shorter time spent in the PACU for the dexamethasone group (0.009).  We did not see a statistical difference in PONV between groups in our study.  The opioid usage of the dexamethasone group in the PACU was significantly less and this could reduce PONV in some patients.

We observed an improvement in the ambulation distance on the day of discharge in the dexamethasone group, which could be due to decreased pain and/or inflammation.  A concern of using steroids around the time of total joint replacement is a risk of infection.  In our study no deep infections occurred in either group. 

This study is limited by its retrospective nature and the small number of patients.  Based on this pilot study perioperative dexamethasone appears to be safe.  Further study is needed with a larger patient population to determine the true benefit of perioperative dexamethasone.

Read more here.

Figure 1

Figure 2

References

  1. Fleischli JW, Adams WR.  Use of postoperative steroids to reduce pain and inflammation.  J Foot Ankle Surg.  1999;38(3):232-237.
  2. Apfel CC, Korttila K, Abdalla M, et al.  A factorial trial of six interventions for the prevention of postoperative nausea and vomitin.  N Engl J Med.  2004;350(24):2441-2451.
  3. Salerno A, Hermann R.  Efficacy and safety of steroid use for postoperative pain relief.  Update and review of the medical literature.  J Bone Joint Surg Am.  2006;88(6):1361-1372.
  4. Ogilvy AJ, Smith G, Nimmo WS, Rowbotham DJ, Smith G.  Postoperative Pain.  Anaesthesia.  Vol 2nd Boston: Blackwell Scientific Publications; 1994:1570-1601.
  5. Vargas JH, III, Ross DG. Corticosteroids and anterior cruciate ligament repair.  Am J Sports Med. 1989;17(4):532-534.
  6. Kizilkaya M, Yildirim OS, Dogan N, Kursad H, Okur A. Analgesic effects of intraarticular sufentanil and sufentanil plus methylprednisolone after arthroscopic knee surgery.  Anesth Analg 2004;98(4):1062-1065.
  7. Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg. 2002;195(5):694-712.

Back to top