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 .
Effects of dexamethasone in preventing postoperative emetic symptoms after total knee replacement surgery: a prospective, randomized, double-blind, vehicle-controlled trial in adult Japanese patients.
BACKGROUND Postoperative emetic symptoms ( nausea , retching , and vomiting ) are common following total joint replacement , with an incidence as high as 83 % when no prophylactic antiemetic is provided . However , most antiemetics currently used in Japan , such as antihistamines ( eg , hydroxyzine ) , butyrophenones ( eg , droperidol ) , and dopamine receptor antagonists ( eg , metoclopramide ) , have been associated with adverse effects ( AEs ) , such as excessive sedation , hypotension , dry mouth , dysphoria , hallucinations , and extrapyramidal symptoms . OBJECTIVE The aim of this study was to assess the efficacy and tolerability of 3 doses of intravenous dexamethasone monotherapy versus vehicle in preventing emetic symptoms after total knee replacement performed under combined general and epidural anesthesia . METHODS This prospect i ve , r and omized , double-blind , vehicle-controlled trial was conducted at the Department of Anesthesiology , University of Tsukuba Institute of Clinical Medicine , Tsukuba , Japan . Adult Japanese patients scheduled to undergo total knee replacement were eligible . Patients were r and omly assigned to 1 of 4 treatment groups : dexamethasone 4 , 8 , or 16 mg , or vehicle ( control ) . Patients received combination anesthesia with sevoflurane and nitrous oxide in pure oxygen ( general ) and lidocaine ( epidural ) . Study drugs were administered intravenously after the completion of surgery . An investigator blinded to treatment assignment monitored patients for emetic symptoms for 24 hours after the patient awoke . Patients rated their satisfaction with the study drug using a linear , 11-point scale ( 0 = complete satisfaction to 10 = complete dissatisfaction ) . Tolerability was assessed by the study investigator using spontaneous reporting and patient interview . RESULTS A total of 80 patients were enrolled ( 58 women , 22 men ; mean [ SD ] age , 59 [ 10 ] years ; mean [ SD ] height , 154 [ 7 ] cm ; mean [ SD ] body weight , 55 [ 7 ] kg ; 20 patients per treatment group ) . The demographic , clinical , and surgical data were comparable between the 4 treatment groups . The rates of emesis-free patients were 35 % ( 7 patients ) , 70 % ( 14 ) , and 75 % ( 15 ) with dexamethasone 4 , 8 , and 16 mg , respectively , compared with 30 % ( 6 ) with vehicle ( P = NS , 0.013 , and 0.005 , respectively ) . Median ( range ) patient satisfaction scores were significantly higher in the groups receiving dexamethasone 8 and 16 mg ( both , 0.0 [ 0 - 9 ] ) compared with controls ( 6.0 [ 0 - 10 ] ) ( P = 0.013 and 0.008 , respectively ) . This effect was not found with the 4-mg dose . No clinical ly serious AEs attributed to the study drug were observed in any of the 4 treatment groups . CONCLUSIONS In this study of a small , select group of adult Japanese patients undergoing total knee replacement , the rates of emesis-free patients were higher with dexamethasone 8 and 16 mg compared with vehicle 24 hours after anesthesia induction . This effect was not found with the 4-mg dose . All treatments were well tolerated
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 .