A Single Preoperative Low Dose of Dexamethasone Is Efficacious in Improving Early Postoperative Pain, Function, Nausea, and Vomiting After Primary Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial.

IF 3.4 2区 医学 Q1 ORTHOPEDICS
Mohammed A Abdelhameed, Ahmed A Khalifa, Mohamed A Mahran, David N Kameel, Hatem M Bakr, Mohammad K Abdelnasser
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引用次数: 0

Abstract

Background: The primary objective was to evaluate a single preoperative low-dose (8 mg) dexamethasone (DXM) efficacy in relieving postoperative pain in patients undergoing total knee arthroplasty (TKA). The secondary objectives were to assess its effect on postoperative nausea and vomiting (PONV), C-reactive protein (CRP) levels, and early wound complications incidence.

Methods: This was a single-center, double-blind, randomized controlled trial. We included 86 unilateral primary TKA divided equally into two groups (placebo [Group A] and DXM [Group B], as a single intravenous dose given after anesthesia). Postoperative pain was assessed as the primary outcome at rest and while walking using a visual analog scale (VAS). Secondary outcomes included PONV evaluated using VAS for postoperative nausea. The following variables were evaluated: the Time Up and Go test, serum CRP, quadriceps muscle power, and wound complications. All outcomes were reported in the first three days and at 14 days follow-up visit.

Results: Both groups' baseline data were comparable. Group B reported significantly less pain at rest and walking throughout all time points (P < 0.001). Group B had fewer vomiting episodes on postoperative days one and two (P = 0.195 and 0.747, respectively) and no difference in PONV VAS score. Group B had significantly lower Time Up and Go test scores for postoperative days one and two (P = 0.029 and 0.016, respectively) and significantly better quadriceps muscle power on postoperative days two and three (P = 0.042 and 0.019, respectively). The Serum CRP levels were significantly less in Group B throughout all follow-up time points (P < 0.001) except on day three (P = 0.302). No wound complications were reported in any patient.

Conclusions: Preoperative single low dose (eight mg) DXM intravenous in patients undergoing unilateral TKA is safe (early postoperatively) and effective for reducing postoperative pain scores, improving early mobility, and reducing inflammatory markers. However, the effect on PONV was less evident.

单次术前低剂量地塞米松对原发性全膝关节置换术后早期疼痛、功能、恶心和呕吐有效:一项随机、双盲、安慰剂对照试验
目的:主要目的是评估术前单次低剂量(8mg)地塞米松(DXM)缓解全膝关节置换术(TKA)患者术后疼痛的疗效。次要目的是评估其对术后恶心呕吐(PONV)、c反应蛋白(CRP)水平和早期伤口并发症发生率的影响。方法:采用单中心、双盲、随机对照试验。我们纳入86例单侧原发性TKA,平均分为两组(安慰剂组(A组)和DXM组(B组),作为麻醉后单次静脉注射(I.V.)剂量)。术后疼痛作为休息和行走时的主要结果,使用视觉模拟评分(VAS)进行评估。次要结果包括使用VAS评估术后恶心的PONV。评估以下变量:Time Up and Go (TUG)测试、血清CRP、股四头肌力量和伤口并发症。所有结果均在前3天和第14天随访时报告。结果:两组的基线数据具有可比性。B组报告在所有时间点休息和行走时疼痛明显减轻(P < 0.001)。B组术后第1天和第2天呕吐次数较少(P值分别为0.195和0.747),PONV VAS评分无差异。B组术后第1、2天TUG测试得分显著低于对照组(P = 0.029、0.016),术后第2、3天股四头肌力量显著高于对照组(P = 0.042、0.019)。除第3天(P = 0.302)外,B组血清CRP水平在所有随访时间点均显著低于对照组(P < 0.001)。所有患者均无伤口并发症。结论:单侧TKA患者术前单次低剂量(8mg) ddxm静脉注射是安全的(术后早期),可有效降低术后疼痛评分,改善早期活动能力,降低炎症标志物。然而,对PONV的影响不太明显。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Arthroplasty
Journal of Arthroplasty 医学-整形外科
CiteScore
7.00
自引率
20.00%
发文量
734
审稿时长
48 days
期刊介绍: The Journal of Arthroplasty brings together the clinical and scientific foundations for joint replacement. This peer-reviewed journal publishes original research and manuscripts of the highest quality from all areas relating to joint replacement or the treatment of its complications, including those dealing with clinical series and experience, prosthetic design, biomechanics, biomaterials, metallurgy, biologic response to arthroplasty materials in vivo and in vitro.
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