Efficacy of Weight-Based Low-Dose Intravenous Dexamethasone for Pain Management Following Total Knee Arthroplasty: A Retrospective Case-Matched Study.

Abstract

Background: Effective management of postoperative pain is essential for promoting recovery and improving overall patient outcomes after total knee arthroplasty (TKA). Intravenous corticosteroids, especially dexamethasone, have become increasingly popular due to their strong anti-inflammatory effects, which can enhance pain control while minimizing side effects. However, the optimal dosing strategy for dexamethasone remains unclear, as most studies have primarily focused on fixed high doses.

Objective: This retrospective case-matched study aimed to evaluate the effectiveness of weight-based low-dose intravenous dexamethasone (0.1 mg/kg) in managing postoperative pain following TKA.

Methods: Patients who underwent unilateral TKA for primary osteoarthritis were retrospectively analyzed and divided into two cohorts based on the timing of their surgery. The control group, consisting of patients who underwent TKA between March 2019 and November 2020, did not receive dexamethasone. In contrast, patients operated on between December 2020 and May 2022 received a preoperative weight-based dose of 0.1 mg/kg intravenous dexamethasone. Postoperative pain was assessed using the Verbal Numerical Rating Scale (VNRS), and fentanyl consumption was recorded over the first 72 hours postoperatively.

Results: The dexamethasone group demonstrated significantly lower pain scores at all measured intervals up to 60 hours postoperatively (p < 0.05) compared to the control group. Additionally, patients receiving dexamethasone required significantly less fentanyl in the first 24 hours and had lower cumulative fentanyl consumption over the entire 72-hour postoperative period (p < 0.001). There were no significant differences between the two groups in terms of hospital stay, deep infection rates, or other complications.

Conclusion: Weight-based low-dose dexamethasone (0.1 mg/kg) appears to be an effective strategy for reducing postoperative pain and opioid use following TKA.