Single-dose dexamethasone reduces dynamic pain after total hip arthroplasty

Anesth Analg. 2008 Apr;106(4):1253-7, table of contents. doi: 10.1213/ANE.0b013e318164f319.

Abstract

Background: Preoperative glucocorticoids reduce postoperative nausea but may also improve analgesia and decrease opioid consumption.

Methods: Fifty consecutive patients undergoing elective, unilateral, primary total hip arthroplasty under spinal anesthesia with propofol sedation received in a randomized, double-blind, placebo-controlled manner either 40 mg of dexamethasone or saline placebo i.v. before the start of surgery. I.v. patient-controlled analgesia morphine, ibuprofen 400 mg p.o. q6 h and acetaminophen 650 mg p.o. q6 h were given for 48 h. Pain (0-10 numeric rating scale, NRS) at rest, side effects, and total cumulative patient-controlled analgesia morphine consumption were recorded q4 h for 48 h. Dynamic pain NRS score was recorded at 24 h. C-reactive protein levels were measured in a subgroup of 25 patients at 48 h.

Results: The intraoperative sedation requirement with propofol was significantly increased in the dexamethasone group (234.6 +/- 160.1 vs 138.8 +/- 122.7 mg, P = 0.02). Dynamic pain was greatly reduced in the dexamethasone group (NRS score: 2.7, 95% CI: 2.2-3.1 vs 6.8, 6.4-7.2; P < 0.0001). There was no significant effect on pain at rest or cumulative morphine consumption at any time. C-reactive protein levels at 48 h were markedly reduced by dexamethasone (52.4 mg/mL, 28.2-76.6 vs 194.2, 168.9-219.4; P < 0.0001). Seven patients in the control group, but only one in the dexamethasone group, were treated for nausea (P = 0.05).

Conclusions: A single, preoperative i.v. dose of dexamethasone 40 mg has a prolonged suppressive effect on the inflammatory response and decreases dynamic pain 24 h after total hip arthroplasty.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analgesia, Patient-Controlled
  • Analgesics / administration & dosage
  • Analgesics / therapeutic use*
  • Anesthetics, Intravenous / therapeutic use
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / therapeutic use*
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Dexamethasone / administration & dosage
  • Dexamethasone / therapeutic use*
  • Double-Blind Method
  • Drug Administration Schedule
  • Female
  • Humans
  • Intraoperative Care
  • Male
  • Middle Aged
  • Pain Measurement
  • Pain, Postoperative / prevention & control*
  • Placebos
  • Postoperative Period
  • Preoperative Care
  • Propofol / therapeutic use

Substances

  • Analgesics
  • Anesthetics, Intravenous
  • Anti-Inflammatory Agents
  • Placebos
  • Dexamethasone
  • Propofol