Jeffrey P. Beckenbaugh, DO






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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

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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

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.

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.

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.

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.

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