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Article: Preoperative dexamethasone for pain relief after total knee arthroplasty: a randomised controlled trial

TitlePreoperative dexamethasone for pain relief after total knee arthroplasty: a randomised controlled trial
Authors
KeywordsFemoral Nerve
Knee Replacement Arthroplasties
Bupivacaine
Issue Date2020
PublisherLippincott Williams & Wilkins. The Journal's web site is located at https://journals.lww.com/ejanaesthesiology/pages/default.aspx
Citation
European Journal of Anaesthesiology, 2020, v. 37 n. 12, p. 1157-1167 How to Cite?
AbstractBACKGROUND: Corticosteroids can reduce pain but the optimal dose and safety profiles are still uncertain. OBJECTIVE: This study aimed to evaluate two different doses of dexamethasone for pain management and their side effects after total knee arthroplasty. DESIGN: A prospective randomised, controlled trial. SETTING: A tertiary teaching hospital in Hong Kong. PATIENTS: One hundred and forty-six patients were randomly allocated to one of three study groups. INTERVENTIONS: Before operation, patients in group D8, D16 and P received dexamethasone 8 mg, dexamethasone 16 mg and placebo (0.9% saline), respectively. MAIN OUTCOME MEASURES: The primary outcome was postoperative pain score. Secondary outcomes were opioid consumption, physical parameters of the knees and side effects of dexamethasone. RESULTS: Compared with placebo, group D16 patients had significantly less pain during maximal active flexion on postoperative day 3 [−1.3 (95% CI, −2.2 to −0.31), P = 0.005]. There was also a significant dose-dependent trend between pain scores and dexamethasone dose (P = 0.002). Compared with placebo, patients in group D16 consumed significantly less opioid [−6.4 mg (95% CI, −11.6 to −1.2), P = 0.025] and had stronger quadriceps power on the first three postoperative days (all P < 0.05). They also had significantly longer walking distance on postoperative day 1 [7.8 m ([95% CI, 0.85 to 14.7), P = 0.023] with less assistance during walking on the first two postoperative days (all P < 0.029) and significantly better quality-of-recovery scores on postoperative day 1 (P = 0.018). There were significant dose-dependent trends between all the above parameters and dexamethasone dose (all P < 0.05). No significant differences were found in the incidence of chronic pain or knee function 3, 6 and 12 months postoperatively. CONCLUSION: Dexamethasone 16 mg given before total knee arthroplasty led to a reduction in postoperative pain, less opioid consumption, stronger quadriceps muscle power, better mobilisation and better overall quality-of-recovery after operation. No long-term improvement in reduction in pain and function of the knee was found. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02767882.
Persistent Identifierhttp://hdl.handle.net/10722/293248
ISSN
2019 Impact Factor: 4.5
2015 SCImago Journal Rankings: 0.999
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorChan, TCW-
dc.contributor.authorCheung, CW-
dc.contributor.authorWong, SSC-
dc.contributor.authorChung, YF-
dc.contributor.authorIrwin, MG-
dc.contributor.authorChan, PK-
dc.contributor.authorFu, H-
dc.contributor.authorYan, CH-
dc.contributor.authorChiu, KY-
dc.date.accessioned2020-11-23T08:13:59Z-
dc.date.available2020-11-23T08:13:59Z-
dc.date.issued2020-
dc.identifier.citationEuropean Journal of Anaesthesiology, 2020, v. 37 n. 12, p. 1157-1167-
dc.identifier.issn0265-0215-
dc.identifier.urihttp://hdl.handle.net/10722/293248-
dc.description.abstractBACKGROUND: Corticosteroids can reduce pain but the optimal dose and safety profiles are still uncertain. OBJECTIVE: This study aimed to evaluate two different doses of dexamethasone for pain management and their side effects after total knee arthroplasty. DESIGN: A prospective randomised, controlled trial. SETTING: A tertiary teaching hospital in Hong Kong. PATIENTS: One hundred and forty-six patients were randomly allocated to one of three study groups. INTERVENTIONS: Before operation, patients in group D8, D16 and P received dexamethasone 8 mg, dexamethasone 16 mg and placebo (0.9% saline), respectively. MAIN OUTCOME MEASURES: The primary outcome was postoperative pain score. Secondary outcomes were opioid consumption, physical parameters of the knees and side effects of dexamethasone. RESULTS: Compared with placebo, group D16 patients had significantly less pain during maximal active flexion on postoperative day 3 [−1.3 (95% CI, −2.2 to −0.31), P = 0.005]. There was also a significant dose-dependent trend between pain scores and dexamethasone dose (P = 0.002). Compared with placebo, patients in group D16 consumed significantly less opioid [−6.4 mg (95% CI, −11.6 to −1.2), P = 0.025] and had stronger quadriceps power on the first three postoperative days (all P < 0.05). They also had significantly longer walking distance on postoperative day 1 [7.8 m ([95% CI, 0.85 to 14.7), P = 0.023] with less assistance during walking on the first two postoperative days (all P < 0.029) and significantly better quality-of-recovery scores on postoperative day 1 (P = 0.018). There were significant dose-dependent trends between all the above parameters and dexamethasone dose (all P < 0.05). No significant differences were found in the incidence of chronic pain or knee function 3, 6 and 12 months postoperatively. CONCLUSION: Dexamethasone 16 mg given before total knee arthroplasty led to a reduction in postoperative pain, less opioid consumption, stronger quadriceps muscle power, better mobilisation and better overall quality-of-recovery after operation. No long-term improvement in reduction in pain and function of the knee was found. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02767882.-
dc.languageeng-
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at https://journals.lww.com/ejanaesthesiology/pages/default.aspx-
dc.relation.ispartofEuropean Journal of Anaesthesiology-
dc.rightsThis is a non-final version of an article published in final form in (provide complete journal citation)-
dc.subjectFemoral Nerve-
dc.subjectKnee Replacement Arthroplasties-
dc.subjectBupivacaine-
dc.titlePreoperative dexamethasone for pain relief after total knee arthroplasty: a randomised controlled trial-
dc.typeArticle-
dc.identifier.emailChan, TCW: timkat@hkucc.hku.hk-
dc.identifier.emailCheung, CW: cheucw@hku.hk-
dc.identifier.emailWong, SSC: wongstan@hku.hk-
dc.identifier.emailChung, YF: chungyf@hku.hk-
dc.identifier.emailIrwin, MG: mgirwin@hku.hk-
dc.identifier.emailChan, PK: cpk464@hku.hk-
dc.identifier.emailFu, H: drhfu@hku.hk-
dc.identifier.emailYan, CH: yanchoi@hku.hk-
dc.identifier.emailChiu, KY: pkychiu@hkucc.hku.hk-
dc.identifier.authorityCheung, CW=rp00244-
dc.identifier.authorityWong, SSC=rp01789-
dc.identifier.authorityIrwin, MG=rp00390-
dc.identifier.authorityYan, CH=rp00303-
dc.identifier.authorityChiu, KY=rp00379-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/EJA.0000000000001372-
dc.identifier.pmid33105245-
dc.identifier.scopuseid_2-s2.0-85095799943-
dc.identifier.hkuros319087-
dc.identifier.volume37-
dc.identifier.issue12-
dc.identifier.spage1157-
dc.identifier.epage1167-
dc.identifier.isiWOS:000587791800009-
dc.publisher.placeUnited Kingdom-
dc.identifier.issnl0265-0215-

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