Effects of high-dose dexamethasone on postoperative opioid consumption and perioperative glycaemia in fast-track primary hip arthroplasty: a retrospective cohort study.
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Abstract
Background and purpose: Standard recommendations for fast-track hip arthroplasty suggest using 8-10 mg of dexamethasone to reduce opioid consumption, with potential benefits of higher doses but scarce data on glycaemic control and complications. This study compares the effects of higher doses versus the standard doses on postoperative opioid consumption, and secondarily, numerical pain scale, glycaemic control, hospital length of stay and postoperative complications.
Methods: Retrospective cohort study of patients scheduled for FAST-TRACK primary hip arthroplasty between 2016 and 2021. Propensity score-matched analyses compared the standard dose group (4-8 mg) versus the high-dose group (16-24 mg).
Results: 168 patients were included (56 with 4-8 mg, 112 with 16-24 mg). After one-to-one propensity score matching, 52 patients were included in the standard group and 52 in the high-dose group. After matching, the median [IQR] opioid consumption in the low-dose group was 10 [0-12] and in the high-dose group was 0 [0-10], with a 95% CI of -1 to 0 (p = 0.016). In the matched group, there was a median difference of 8 mg/dL (95% CI, -2 to 7, P < 0.05) in the immediate postoperative glycaemia, of 17 mg/dl (95% CI, -2 to 14, P < 0.05) in glycaemia at 24 h and of -1 day (95% CI, -1 to 0, P < 0.05) in hospital stay. No differences in the numerical pain scale and postoperative complications were found.
Conclusion: High-dose dexamethasone slightly increased perioperative glycaemia while reducing opioid consumption and shortening hospital length of stay.
期刊介绍：
International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters.
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