title: Effects of dexamethasone on local infiltration analgesia in total knee arthroplasty: a randomized controlled trial.
abstract: OBJECTIVE
  Intraoperative local infiltration analgesia has gained increasing popularity in joint replacement surgery. Because there is considerable variation among drug combinations, analgesic effects of each drug are not well understood. The purpose of this study was to clarify the efficacy of the addition of steroid to local anaesthetics in local infiltration analgesia during total knee arthroplasty.
  
  
  METHODS
  Forty patients were randomly allocated to the steroid or control group. Patients in the steroid group received peri-articular injection of ropivacaine, dexamethasone and isepamicin, while dexamethasone was omitted from the analgesic mixture in the control group. Primary outcome was pain severity at rest using 100 mm visual analogue scale.
  
  
  RESULTS
  Pain severity in the steroid group was lower than control group and there were significant differences between groups at post-operative day 1 and 3. Reduction in post-operative pain was associated with a decrease in serum C-reactive protein and interleukin 6 in drainage fluid. The number of patients who were able to perform straight leg raise within post-operative day 2 was 15/20 in the steroid group, which was significantly higher than the control group 5/20.
  
  
  CONCLUSIONS
  Adding steroid to local anaesthetics in local infiltration analgesia reduced inflammation both locally and systemically, resulting in significant early pain relief and rapid recovery in total knee arthroplasty.
authors.affiliation: Department of Orthopedic Surgery, Kochi University, 185-1 Oko-cho, Nankoku, Kochi, 783-8505, Japan, ikeuchim@kochi-u.ac.jp.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ikeuchi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kamimoto
authors.forename: Masashi
authors.initials: M
authors.lastname: Izumi
authors.forename: Kayo
authors.initials: K
authors.lastname: Fukunaga
authors.forename: Koji
authors.initials: K
authors.lastname: Aso
authors.forename: Natsuki
authors.initials: N
authors.lastname: Sugimura
authors.forename: Masataka
authors.initials: M
authors.lastname: Yokoyama
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Tani
mesh_terms: D000368:Aged; D000577:Amides / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D002097:C-Reactive Protein / Q000378:metabolism; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007270:Injections, Intra-Articular; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D020370:Osteoarthritis, Knee / Q000601:surgery*; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D000077212:Ropivacaine; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D005839:Gentamicins; D015850:Interleukin-6; D000077212:Ropivacaine; D003907:Dexamethasone; D002097:C-Reactive Protein; C016927:isepamicin