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 .
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 r and omized , double-blind , placebo-controlled manner either 40 mg of dexamethasone or saline placebo IV before the start of surgery . IV patient-controlled analgesia morphine , ibuprofen 400 mg po q6 h and acetaminophen 650 mg po 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 IV dose of dexamethasone 40 mg has a prolonged suppressive effect on the inflammatory response and decreases dynamic pain 24 h after total hip arthroplasty
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 .