سامانه مدیریت نشریات علمی دانشگاه علوم پزشکی مشهد

Lung, Brandon, Le, Ryan, McLellan, Maddison, Callan, Kylie, Donnelly, Megan, Yi, Justin, Birring, Paramveer, McMaster, William, Yang, Steven, So, David. (1401). Repeat High-Dose Dexamethasone May Improve Recovery 48 Hours after Total Hip Arthroplasty. , 11(3), 188-196. doi: 10.22038/abjs.2022.65130.3124
Brandon E. Lung; Ryan Le; Maddison McLellan; Kylie Callan; Megan Donnelly; Justin Yi; Paramveer Birring; William C. McMaster; Steven Yang; David H. So. "Repeat High-Dose Dexamethasone May Improve Recovery 48 Hours after Total Hip Arthroplasty". , 11, 3, 1401, 188-196. doi: 10.22038/abjs.2022.65130.3124
Lung, Brandon, Le, Ryan, McLellan, Maddison, Callan, Kylie, Donnelly, Megan, Yi, Justin, Birring, Paramveer, McMaster, William, Yang, Steven, So, David. (1401). 'Repeat High-Dose Dexamethasone May Improve Recovery 48 Hours after Total Hip Arthroplasty', , 11(3), pp. 188-196. doi: 10.22038/abjs.2022.65130.3124
Lung, Brandon, Le, Ryan, McLellan, Maddison, Callan, Kylie, Donnelly, Megan, Yi, Justin, Birring, Paramveer, McMaster, William, Yang, Steven, So, David. Repeat High-Dose Dexamethasone May Improve Recovery 48 Hours after Total Hip Arthroplasty. , 1401; 11(3): 188-196. doi: 10.22038/abjs.2022.65130.3124

Repeat High-Dose Dexamethasone May Improve Recovery 48 Hours after Total Hip Arthroplasty

The Archives of Bone and Joint Surgery
مقاله 7، دوره 11، شماره 3، خرداد 2023، صفحه 188-196    اصل مقاله (737.38 K)
نوع مقاله: RESEARCH PAPER
شناسه دیجیتال (DOI): 10.22038/abjs.2022.65130.3124
نویسندگان
Brandon E. Lung* ؛ Ryan Le؛ Maddison McLellan؛ Kylie Callan؛ Megan Donnelly؛ Justin Yi؛ Paramveer Birring؛ William C. McMaster؛ Steven Yang؛ David H. So
University of California, Irvine Department of Orthopedic Surgery, Orange, CA, USA
چکیده
Objectives: Perioperative dexamethasone is an effective anti-emetic and systemic analgesic in total hip arthroplasty (THA) that may reduce opioid consumption and enhance rapid recovery. However, there is no consensus on the optimal perioperative dosing that is safe and effective for faster rehabilitation and improved pain control while maintaining safe blood glucose levels. Methods: A retrospective review of 101 primary THA patients at a single institution who received perioperative dexamethasone was conducted. Patients were stratified by dexamethasone induction dosage (10 mg as high, <6mg as low) and whether a repeat dose was given 16-24 hours postoperatively. Age, gender, BMI, diabetes status, and ASA were controlled between groups. The pain was evaluated with inpatient morphine milligram equivalents (MME) requirements and visual analog scale (VAS) at 8, 16, and 24 hours postoperatively. Mobility was assessed by inpatient ambulation distance, Boston AM-PAC mobility score, and percentage of gait assistance as determined by a physical therapist. Secondary outcomes included postoperative nausea and vomiting (PONV) limiting therapy sessions, PONV requiring breakthrough anti-emetics, glucose levels, surgical site infection, wound healing complications, and discharge destination. Results: : Compared to patients receiving one dose of high or low dexamethasone, patients receiving two dosages of high-dose dexamethasone had significantly further ambulation distance and lower percentage of gait assistance on postoperative day 2. A generalized linear model also predicted that any repeat dexamethasone, regardless of dosage, significantly improved ambulation distance and gait assistance compared to the one-dose cohort. There was no statistically significant difference between VAS scores, MME requirements, PONV, postoperative glucose levels >200, discharge destination, or risk of infection between groups. Conclusion: A repeat high-dose dexamethasone, the morning after surgery, may improve percentage of gait assistance and ambulation endurance on postoperative day two. There was no risk of uncontrolled glucose levels or infections compared to receiving one dose of dexamethasone at induction. Level of evidence: III
کلیدواژه‌ها
Dexamethasone؛ Peri-operative management؛ Pain control؛ Patient outcomes؛ Total hip arthroplasty
مراجع
  1. Premkumar A, Kolin DA, Farley KX, et al. Projected Economic Burden of Periprosthetic Joint Infection of the Hip and Knee in the United States. J Arthroplasty. 2021;36(5):1484-1489.e3. doi: 10.1016/j.arth.2020.12.005.
  2. Oseka L, Pecka S. Anesthetic Management in Early Recovery After Surgery Protocols for Total Knee and Total Hip Arthroplasty. AANA J. 2018;86(1):32-39.
  3. Weibel S, Rücker G, Eberhart LH, et al. Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis. Cochrane Database Syst Rev. 2020;10(10):CD012859. doi: 10.1002/14651858.CD012859.pub2.
  4. Lucero CM, García-Mansilla A, Zanotti G, Comba F, Slulilitel PA, Buttaro MA. A repeat dose of perioperative dexamethasone can effectively reduce pain, opioid requirement, time to ambulation, and in-hospital stay after total hip arthroplasty: a prospective randomized controlled trial. J Arthroplasty. 2021;36(12):P3938-3944. doi: 10.1016/j.arth.2021.08.020.
  5. Polderman JA, Farhang-Razi V, Van Dieren S, et al. Adverse side effects of dexamethasone in surgical patients. Cochrane Database Syst Rev. 2018;11(11):CD011940. doi: 10.1002/14651858.CD011940.pub3
  6. Keohane D, Sheridan GA, Harty J. Perioperative dexamethasone administration reduces 'on-demand' opioid requirements in bilateral total hip arthroplasty. Ir J Med Sci. 2021; 190(4):1423-1427. doi: 10.1007/s11845-020-02486-y.
  7. Backes JR, Bentley JC, Politi JR, Chambers BT. Dexamethasone reduces length of hospitalization and improves postoperative pain and nausea after total joint arthroplasty: a prospective, randomized controlled trial. J Arthroplasty. 2013;28(8 Suppl):11-7. doi: 10.1016/j.arth.2013.05.041.
  8. Lei Y, Huang Z, Huang Q, Huang W, Pei F. Repeat Doses of Dexamethasone up to 48 Hours Further Reduce Pain and Inflammation After Total Hip Arthroplasty: A Randomized Controlled Trial. J Arthroplasty. 2020;35(11):3223-3229. doi: 10.1016/j.arth.2020.06.023.
  9. Yue C, Wei R, Liu Y. Perioperative systemic steroid for rapid recovery in total knee and hip arthroplasty: a systematic review and meta-analysis of ran- domized trials. J Orthop Surg Res. 2017;12(1):100. doi: 10.1186/s13018-017-0601-4.
  10. Lei Y, Huang Z, Huang Q, Pei F, Huang W. Is a split-dose intravenous dexamethasone regimen superior to a single high dose in reducing pain and improving function after total hip arthroplasty? A randomized blinded placebo-controlled trial. Bone Joint J. 2020;102-B(11):1497-1504. doi: 10.1302/0301-620X.102B11.BJJ-2020-1078.R1.
  11. Louati K, Berenbaum F. Fatigue in chronic inflammation-a link to pain pathwaysArthritis Res Ther. 2015;17(1):1-0. doi: 10.1186/s13075-015-0784-1.
  12. Wylde V, Rooker J, Halliday L, Blom A. Acute postoperative pain at rest after hip and knee arthroplasty: severity, sensory qualities and impact on sleep. Orthop Traumatol Surg Res. 2011;97(2):139-44. doi: 10.1016/j.otsr.2010.12.003.
  13. Johnson DB, Lopez MJ, Kelley B. Dexamethasone (StatPearls. (Treasure Island (FL. StatPearls Publishing; 2021.
  14. Dissanayake R, Du HN, Robertson IK, Ogden K, Wiltshire K, Mulford JS. Does dexamethasone reduce hospital readiness for discharge, pain, nausea, and early patient satisfaction in hip and knee arthroplasty? A randomized, controlled trial. J Arthroplasty. 2018; 33(11):3429-3436. doi: 10.1016/j.arth.2018.07.013. Epub 2018 Jul 19.
  15. Rubin GJ, Hotopf M. Systematic review and meta‐analysis of interventions for postoperative fatigue. Br J Surg. 2002; 89(8):971-84.doi:10.1046/j.1365 2168.2002.02138.x
  16. Bergeron S, Kardash K, Huk O, et al. Perioperative Dexamethasone does not affect functional outcome in total hip arthroplasty. Clin Orthop Relat Res. 2009;467(6):1463-7. doi: 10.1007/s11999-009-0733-x.
  17. Elsaid RM, Namrouti AS, Samara AM, Sadaqa W, Zyoud SH. Assessment of pain and postoperative nausea and vomiting and their association in the early postoperative period: an observational study from Palestine. BMC Surg. 2021; 21(1):177. doi: 10.1186/s12893-021-01172-9.
  18. Romundstad L, Breivik H, Niemi G, Helle A, Stubhaug A. Methylprednisolone intravenously 1 day after surgery has sustained analgesic and opioid-sparing effects. Acta Anaesthesiol Scand. 2004; 48(10):1223-31. doi: 10.1111/j.1399-6576.2004.00480.x.
  19. Dhatariya II K. Does dexamethasone-induced hyperglycaemia contribute to postoperative morbidity and mortality? Br J Anaesth. 2013;110(5):674-5. doi: 10.1093/bja/aet010.
  20. Xu B, Ma J, Huang Q, Huang ZY, Zhang SY, Pei FX. Two doses of low-dose perioperative dexamethasone improve the clinical outcome after total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc. 2018;26(5):1549-1556. doi: 10.1007/s00167-017-4506-x.
  21. Yue C, Wei R, Liu Y. Perioperative systemic steroid for rapid recovery in total knee and hip arthroplasty: a systematic review and meta-analysis of randomized trials. J Orthop Surg Res. 2017;12(1):100. doi: 10.1186/s13018-017-0601-4.
  22. McLawhorn AS, Beathe J, YaDeau J, et al. Effects of steroids on thrombogenic markers in patients undergoing unilateral total knee arthroplasty: a prospective, double-blind, randomized controlled trial. J Orthop Res. 2015;33(3):412-6. doi: 10.1002/jor.22776.
  23. Van Deventer SJ, Büller HR, ten Cate JW, Aarden LA, Hack CE, Sturk A. Experimental endotoxemia in humans: analysis of cytokine release and coagulation, fibrinolytic, and complement pathways. Blood. 1990;76(12):2520-6.
  24. Nurok M, Cheng J, Romeo GR, Vecino SM, Fields KG, YaDeau JT. Dexametha- sone and perioperative blood glucose in patients undergoing total joint arthroplasty: a retrospective study. J Clin Anesth. 2017;37:116-122. doi: 10.1016/j.jclinane.2016.11.012. 
  25. Salerno A, Hermann R. Current concepts review: efficacy and safety of steroid Use for postoperative pain relief. J Bone Joint Surg Am. 2006;88(6):1361-72. doi: 10.2106/JBJS.D.03018.
 

آمار
تعداد مشاهده مقاله: 551
تعداد دریافت فایل اصل مقاله: 477