Preemptive low-dose dexamethasone reduces postoperative emesis and pain after TKA: a randomized controlled study

Abstract

Background: Dexamethasone is a potent analgesic and antiemetic. However, the benefit of dexamethasone after TKA is unclear, as is the efficacy in a current multimodal regime.

Questions/purposes: We determined (1) whether the addition of dexamethasone to a protocol including ramosetron further reduces postoperative emesis compared with ramosetron alone; (2) whether it reduces postoperative pain; and (3) whether it increases the risk for wound complications in a current multimodal regime after TKA.

Methods: We randomized 269 patients undergoing TKAs to receive dexamethasone (10 mg) 1 hour before surgery and ramosetron immediately after surgery (Dexa-Ra group, n = 135), or ramosetron alone (Ra group, n = 134). We recorded the incidence of postoperative nausea and vomiting (PONV), severity of nausea, incidence of antiemetic requirement, complete response, pain level, and opioid consumption. Patients were assessed 0 to 6, 6 to 24, 24 to 48, and 48 to 72 hours postoperatively. In addition, patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery.

Results: The Dexa-Ra group had a lower incidence of PONV during the entire 72-hour evaluation period and experienced less severe nausea for the first 6 hours after TKA, although not between 6 to 72 hours. Overall use of a rescue antiemetic was less frequent, and complete response was more frequent in the Dexa-Ra group. Patients in the Dexa-Ra group experienced lower pain and consumed less opioids during the 6- to 24-hour period and during the overall study period. No differences were found in wound complications between the groups, and each group had one case of periprosthetic joint infection.

Conclusions: Patients who received prophylactic dexamethasone in addition to ramosetron had reduced postoperative emesis and pain without increased risks for wound complications, compared with patients who received ramosetron alone in patients managed using a multimodal regimen after TKA.

Fig. 1

A flow diagram shows the study design. FNB = femoral nerve block; PCA = patient-controlled analgesia.

Fig. 2

A graph shows nausea severity according to VAS scores during the 72 hours after surgery. Patients in the Dexa-Ra group experienced less severe nausea than those in the Ra group during the first 6 hours after surgery. Error bars represent 95% CIs. *p < 0.05; p values in parentheses are uncorrected values before the Bonferroni analysis.

Fig. 3

Pain level according to VAS scores during the 72 hours after surgery is shown. Patients in the Dexa-Ra group experienced less severe pain than those in the Ra group during the 6- to 24-hour period. Error bars represent 95% CIs. *p < 0.05; p values in parentheses are uncorrected values before the Bonferroni analysis.

Fig. 4A–B

Fentanyl consumption via intravenous PCA, with 95% CIs, during (A) each period and during the (B) whole study period are shown. Patients in the Dexa-Ra group consumed less opioid during the 6- to 24-hour period and less overall opioid during the whole 72-hour period. Values with a significant difference (p < 0.05) are marked with an asterisk. P values in parentheses are the uncorrected values before Bonferroni analysis.