Meta- analysis showed that high-dose systemic steroid ( dexamethasone > 0.1 mg/kg ) rather than low dose is effective to reduce postoperative nausea and vomiting and postoperative acute pain ( within 24 h ) .
In addition , systemic steroid is associated within faster functional rehabilitation and greater inflammation control .
On the other h and , systemic steroid is associated with a higher level of postoperative serum glucose on the operation day .
Conclusions Our study suggests that by providing lower incidence of postoperative nausea and vomiting and less postoperative acute pain , high-dose systemic steroid plays a critical role in rapid recovery to TKA and THA .
The preliminary results also show the superior possibility of systemic steroid in functional rehabilitation and inflammation control .
Background Perioperative systemic steroid administration for rapid recovery in total knee and hip arthroplasty ( TKA/THA ) is an important and controversial topic .
We conducted this systematic review and meta- analysis to evaluate the overall benefits and harms of perioperative systemic steroid in patients undergoing TKA and THA .
Steroid modulation of cytokine release and desmosine levels in bilateral total knee replacement: a prospective, double-blind, randomized controlled trial.
BACKGROUND The perioperative inflammatory response as measured by elevated levels of interleukin-6 ( IL-6 ) has been linked to acute respiratory distress syndrome , postoperative confusion , and fever . Because of the extent of surgery , patients undergoing bilateral total knee arthroplasty may be at high risk of complications . We had found a significant decrease in IL-6 in patients having bilateral total knee replacement who received two doses of 100 mg of hydrocortisone eight hours apart ; however , by twenty-four hours , IL-6 levels were equal to those in the group that received a placebo . In the present study , we investigated whether the administration of three doses would reduce IL-6 levels at twenty-four hours and affect other outcomes such as desmosine level , a marker of lung injury . METHODS After institutional review board approval , a total of thirty-four patients ( seventeen patients and seventeen control subjects ) were enrolled in this double-blind , r and omized , placebo-controlled study . Three doses of intravenous hydrocortisone ( 100 mg ) or placebo were given eight hours apart . Urinary desmosine levels were obtained at baseline and at one and three days postoperatively . The level of IL-6 was measured at baseline and at six , ten , twenty-four , and forty-eight hours postoperatively . Pain scores , presence of fever , and functional outcomes were recorded . RESULTS The level of IL-6 increased in both groups , but was significantly higher in the control group , peaking at twenty-four hours ( mean and st and ard deviation , 623.74 ± 610.35 pg/mL versus 148.13 ± 119.35 pg/mL ; p = 0.006 ) . Urinary desmosine levels significantly increased by twenty-four hours in the control group , but remained unchanged in the study group ( 134.75 ± 67.88 pmol/mg and 79.45 ± 46.30 pmol/mg , respectively ; p = 0.006 ) . Pain scores at twenty-four hours were significantly lower in the study group ( 1.4 ± 0.9 versus 2.4 ± 1.2 ; p = 0.01 ) as was the presence of fever ( 11.8%versus 47.1 % ; p = 0.03 ) . Range of motion at the knee was significantly greater in the study group ( 81.6 ± 11.6 versus 70.6 ± 14.0 in the right knee [ p = 0.02 ] and 81.4 ± 11.3 versus 73.4 ± 9.4 in the left knee [ p = 0.03 ] ) . CONCLUSIONS Hydrocortisone ( 100 mg ) given over three doses , each eight hours apart , decreased and maintained a lower degree of inflammation with bilateral total knee replacement as measured by IL-6 level . Corticosteroids decreased the prevalence of fever , lowered visual analog pain scores , and improved knee motion . The significantly lower values of desmosine in the study group suggest that this treatment may be protective against lung injury
Meta- analysis showed that high-dose systemic steroid ( dexamethasone > 0.1 mg/kg ) rather than low dose is effective to reduce postoperative nausea and vomiting and postoperative acute pain ( within 24 h ) .
In addition , systemic steroid is associated within faster functional rehabilitation and greater inflammation control .
On the other h and , systemic steroid is associated with a higher level of postoperative serum glucose on the operation day .
Conclusions Our study suggests that by providing lower incidence of postoperative nausea and vomiting and less postoperative acute pain , high-dose systemic steroid plays a critical role in rapid recovery to TKA and THA .
The preliminary results also show the superior possibility of systemic steroid in functional rehabilitation and inflammation control .
Background Perioperative systemic steroid administration for rapid recovery in total knee and hip arthroplasty ( TKA/THA ) is an important and controversial topic .
We conducted this systematic review and meta- analysis to evaluate the overall benefits and harms of perioperative systemic steroid in patients undergoing TKA and THA .