Efficacy of Systemic Steroid Use Given One Day after Total Knee Arthroplasty for Pain and Nausea: A Randomized Controlled Study

Background

Systemic steroid has been used to control pain and nausea in in total knee arthroplasty (TKA), but most studies recommend a single dose administration prior to, or during, surgery. This study aimed to determine the efficacy of administration on one day postoperatively.

Methods

Patients who were scheduled to undergo TKA were randomly assigned to the following groups: control group, receiving normal saline injection; group 1, receiving 10 mg dexamethasone intravenously (iv) 1 hour (h) before surgery; group 2, receiving 0.1 mg/kg dexamethasone (iv) 24 h after surgery; or group 3, receiving 0.2 mg/kg dexamethasone (iv) 24 h after surgery (n = 44–46 per group). Primary outcomes were pain and nausea visual analogue scale (VAS). Secondary outcomes were analgesic administration, rescue antiemetic administration, C-reactive protein (CRP), range of motion (ROM), and complications.

Results

Postoperative pain and nausea remained high for 48 h post-TKA. Group 1 had lower pain and nausea VAS scores than did the control group (p < 0.01) for only 24 h post-TKA. Groups 2 and 3 had lower pain and nausea VAS scores than did the control group and group 1 (p < 0.01) 48 h post-TKA. Analgesic and antiemetic administration were significantly lower in groups 2 and 3 than in the control group during 48 h after TKA. There were no differences in CRP level and ROM, and complications were not detected.

Conclusions

The effect of pre- and postoperative administration of dexamethasone for controlling pain and nausea was observed only for 24h. Considering that severe pain and nausea persisted for more than 48h after TKA, additional administration of dexamethasone at one day postoperatively is suggested.