Document Detail


Perioperative dexamethasone does not affect functional outcome in total hip arthroplasty.
MedLine Citation:
PMID:  19224304     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Current trends in orthopaedic surgery have explored different forms of adjuvant treatments to minimize postoperative pain and the risk of nausea and vomiting. A small single preoperative dose of dexamethasone, as part of a comprehensive multimodal analgesic regimen in low-risk patients undergoing total hip arthroplasty (THA), provides antiemetic and opioid-sparing effects but the longer-term effects on pain, complications, or function are not known. We therefore asked whether such a routine would affect longer-term pain, complications, or function. Fifty patients undergoing elective primary THA using spinal anesthesia were initially randomized to receive either dexamethasone (40 mg intravenous) or saline placebo. The patients, anesthesiologists, nurses, and research coordinators were blinded to the study arms. The functional outcome was measured using the Harris hip score. Outcomes were assessed 6 weeks and 1 year postoperatively. We observed no difference in resting pain between the two groups at either time period. Both groups had similar functional outcome scores for the total Harris hip score and individual scoring items at each followup interval. There were no wound complications, deep infections, or osteonecrosis in the contralateral hip at 1-year followup. We recommend the addition of a small single preoperative dose of dexamethasone to a comprehensive multimodal analgesic regimen in low-risk patients given its immediate antiemetic and opioid-sparing effects, and absence of subsequent effects. Level of Evidence: Level II, therapeutic study (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.
Authors:
Stephane G Bergeron; Kenneth J Kardash; Olga L Huk; David J Zukor; John Antoniou
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2009-02-18
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  467     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-04-28     Completed Date:  2009-06-05     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1463-7     Citation Subset:  AIM; IM    
Affiliation:
Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Analysis of Variance
Antiemetics / therapeutic use*
Arthroplasty, Replacement, Hip
Chi-Square Distribution
Dexamethasone / therapeutic use*
Female
Humans
Male
Pain Measurement
Pain, Postoperative / prevention & control*
Postoperative Nausea and Vomiting / prevention & control*
Questionnaires
Range of Motion, Articular
Recovery of Function
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antiemetics; 50-02-2/Dexamethasone
Comments/Corrections

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