Relationship between dexamethasone added to periarticular anesthetic infiltration and postoperative nausea and vomiting following total knee arthroplasty under general anesthesia: a retrospective observational study

Toshiyuki Yano; Takashi Imaizumi; Hidemi Matsu-Ura; Tomoki Takahashi

doi:10.1186/s40981-020-00372-1

Relationship between dexamethasone added to periarticular anesthetic infiltration and postoperative nausea and vomiting following total knee arthroplasty under general anesthesia: a retrospective observational study

JA Clin Rep. 2020 Aug 21;6(1):66. doi: 10.1186/s40981-020-00372-1.

Authors

Toshiyuki Yano¹, Takashi Imaizumi², Hidemi Matsu-Ura³, Tomoki Takahashi⁴

Affiliations

¹ Division of Anesthesia, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kita-ku, Kumamoto, 860-8518, Japan. yano@juryo.or.jp.
² Division of Anesthesia, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kita-ku, Kumamoto, 860-8518, Japan.
³ Department of Pharmacy, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kita-ku, Kumamoto, 860-8518, Japan.
⁴ Department of Orthopedic Surgery, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kita-ku, Kumamoto, 860-8518, Japan.

Abstract

Background: Periarticular anesthetic infiltration (PAI) with a corticosteroid is a modality for pain control following total knee arthroplasty (TKA). Systemic corticosteroids are an established antiemetic for the prophylaxis of postoperative nausea and vomiting (PONV). The purpose of this retrospective observational study was to elucidate the relationship between dexamethasone added to PAI and PONV in patients who underwent TKA.

Methods: Data from 435 patients who received PAI using ropivacaine with or without dexamethasone were reviewed. The primary outcome was the incidence of PONV within 24 h following TKA. The incidence of deep incisional and organ/space surgical site infection (SSI) within the first year was also assessed.

Results: The overall incidence of PONV was 23.2%. A multivariate logistic regression analysis showed that dexamethasone added to PAI was independently associated with a reduced incidence of PONV (adjusted odds ratio, 0.23; 95% confidence interval, 0.12-0.44, P < 0.001). The incidence of PONV and rescue analgesic requirements within 24 h were lower in patients who received PAI with dexamethasone than in those who received PAI alone (19.5% vs 49.1%, P < 0.001, 7.9% vs 29.1%, P < 0.001, respectively). SSI developed in one out of the 55 patients who received PAI alone, but in none of those who received PAI with dexamethasone.

Conclusions: Dexamethasone added to PAI for postoperative pain management was independently associated with a lower risk of PONV within 24 h of TKA.

Keywords: Glucocorticoids; Multimodal cocktail; PONV; Periarticular injection; Postoperative analgesia; Prosthetic joint infection; Steroids; Surgical site infection.