title: Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial.
abstract: BACKGROUND
  High-dose glucocorticoid may reduce postsurgical pain and improve recovery. We hypothesized that 125 mg methylprednisolone (MP) would reduce time to meet functional discharge criteria after total hip arthroplasty (THA).
  
  
  METHODS
  Forty-eight patients undergoing unilateral THA under spinal anaesthesia were consecutively included in this randomized, double-blind, placebo-controlled trial receiving preoperative i.v. MP or saline. All patients received a standardized, multimodal analgesic regime with paracetamol, celecoxib, and gabapentin. The primary outcome was time to meet well-defined functional discharge criteria. Secondary outcomes were handgrip strength and endurance, pain, nausea, vomiting, fatigue, sleep quality, and rescue analgesic-, antiemetic-, and hypnotic medicine requirements. The inflammatory response measured by C-reactive protein (CRP) and actual length of stay were also registered. Discharge criteria were assessed twice daily (at 09:00 and 14:00 h) until discharge. Other outcomes were assessed at 2, 4, 6, 8, and 24 h after operation, and also in a questionnaire from postoperative day (POD) 1-4.
  
  
  RESULTS
  Time to meet discharge criteria was [median (IQR) (95% CI), MP vs placebo]: 23.5 (23.3-23.7) (17.8-43.8) vs 23.5 (23.0-23.8) (20.0-46.8) h, the mean difference (95% CI) being -1.3 (-4.7 to 2.2) h, P=0.65. Overall pain for the first 24 h after surgery was significantly reduced in the MP vs the placebo group (P<0.01), as was CRP at 24 h (P<0.0001). No other between-group differences were observed. No drug-related complications were observed at follow-up on POD30.
  
  
  CONCLUSIONS
  MP 125 mg i.v. before surgery added to a multimodal oral analgesic regime did not reduce time to meet functional discharge criteria after THA, but improved analgesia for the first 24 h.
authors.affiliation: Department of Anaesthesiology, Hvidovre University Hospital, Kettegård Allé 30, DK-2650 Copenhagen, Denmark. lunn@dadlnet.dk
authors.forename: T H
authors.initials: TH
authors.lastname: Lunn
authors.forename: L Ø
authors.initials: LØ
authors.lastname: Andersen
authors.forename: B B
authors.initials: BB
authors.lastname: Kristensen
authors.forename: H
authors.initials: H
authors.lastname: Husted
authors.forename: L
authors.initials: L
authors.lastname: Gaarn-Larsen
authors.forename: T
authors.initials: T
authors.lastname: Bandholm
authors.forename: S
authors.initials: S
authors.lastname: Ladelund
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D004311:Double-Blind Method; D005260:Female; D018737:Hand Strength; D006801:Humans; D007902:Length of Stay; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D053580:Muscle Strength; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D010351:Patient Discharge; D020127:Recovery of Function; D017409:Sufentanil / Q000008:administration & dosage / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000893:Anti-Inflammatory Agents; D017409:Sufentanil; D008775:Methylprednisolone