Single-dose dexamethasone reduces dynamic pain after total hip arthroplasty.
BACKGROUND
Preoperative glucocorticoids reduce postoperative nausea but may also improve analgesia and decrease opioid consumption.


METHODS
Fifty consecutive patients undergoing elective, unilateral, primary total hip arthroplasty under spinal anesthesia with propofol sedation received in a randomized, double-blind, placebo-controlled manner either 40 mg of dexamethasone or saline placebo i.v. before the start of surgery. I.v. patient-controlled analgesia morphine, ibuprofen 400 mg p.o. q6 h and acetaminophen 650 mg p.o. q6 h were given for 48 h. Pain (0-10 numeric rating scale, NRS) at rest, side effects, and total cumulative patient-controlled analgesia morphine consumption were recorded q4 h for 48 h. Dynamic pain NRS score was recorded at 24 h. C-reactive protein levels were measured in a subgroup of 25 patients at 48 h.


RESULTS
The intraoperative sedation requirement with propofol was significantly increased in the dexamethasone group (234.6 +/- 160.1 vs 138.8 +/- 122.7 mg, P = 0.02). Dynamic pain was greatly reduced in the dexamethasone group (NRS score: 2.7, 95% CI: 2.2-3.1 vs 6.8, 6.4-7.2; P < 0.0001). There was no significant effect on pain at rest or cumulative morphine consumption at any time. C-reactive protein levels at 48 h were markedly reduced by dexamethasone (52.4 mg/mL, 28.2-76.6 vs 194.2, 168.9-219.4; P < 0.0001). Seven patients in the control group, but only one in the dexamethasone group, were treated for nausea (P = 0.05).


CONCLUSIONS
A single, preoperative i.v. dose of dexamethasone 40 mg has a prolonged suppressive effect on the inflammatory response and decreases dynamic pain 24 h after total hip arthroplasty.
Kardash
Kenneth J
KJ
Department of Anesthesia, Sir Mortimer B Davis-Jewish General Hospital, McGill University, Montreal, Canada. kenneth.kardash@mcgill.ca
Sarrazin
Frederic
F
Tessler
Michael J
MJ
Velly
Ana M
AM
D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010919:Placebos; D011184:Postoperative Period; D011300:Preoperative Care; D015742:Propofol / Q000627:therapeutic use
D000700:Analgesics; D018686:Anesthetics, Intravenous; D000893:Anti-Inflammatory Agents; D010919:Placebos; D003907:Dexamethasone; D015742:Propofol