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 .
Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study
Background Dexamethasone is a potent analgesic and antiemetic . However , the benefit of dexamethasone after TKA is unclear , as is the efficacy in a current multimodal regime . Questions / purpose sWe determined ( 1 ) whether the addition of dexamethasone to a protocol including ramosetron further reduces postoperative emesis compared with ramosetron alone ; ( 2 ) whether it reduces postoperative pain ; and ( 3 ) whether it increases the risk for wound complications in a current multimodal regime after TKA . Methods We r and omized 269 patients undergoing TKAs to receive dexamethasone ( 10 mg ) 1 hour before surgery and ramosetron  immediately after surgery ( Dexa-Ra  group , n = 135 ) , or  ramosetron alone ( Ra group , n = 134 ) . We recorded the incidence of postoperative nausea and vomiting ( PONV ) , severity of nausea , incidence of antiemetic requirement , complete response , pain level , and opioid consumption . Patients were assessed 0 to 6 , 6 to 24 , 24 to 48 , and 48 to 72 hours postoperatively . In addition , patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery . Results The Dexa-Ra group had a lower incidence of PONV during the entire 72-hour evaluation period and experienced less severe nausea for the first 6 hours after TKA , although not between 6 to 72 hours . Overall use of a rescue antiemetic was less frequent , and complete response was more frequent in the Dexa-Ra group . Patients in the Dexa-Ra group experienced lower pain and consumed less opioids during the 6- to 24-hour period and during the overall study period . No differences were found in wound complications between the groups , and each group had one case of periprosthetic joint infection . Conclusions Patients who received prophylactic dexamethasone in addition to ramosetron had reduced postoperative emesis and pain without increased risks for wound complications , compared with patients who received ramosetron alone in patients managed using a multimodal regimen after TKA.Level of Evidence Level I , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence
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 .