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Randomized Controlled Trial
. 2022 Jan 4:376:e067325.
doi: 10.1136/bmj-2021-067325.

Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial

Kasper Smidt Gasbjerg  1 , Daniel Hägi-Pedersen  2   3   4 , Troels Haxholdt Lunn  2   5 , Christina Cleveland Laursen  5   6 , Majken Holmqvist  7 , Louise Ørts Vinstrup  5   6 , Mette Ammitzboell  8 , Karina Jakobsen  1 , Mette Skov Jensen  1 , Marie Jøhnk Pallesen  8 , Jens Bagger  8 , Peter Lindholm  9 , Niels Anker Pedersen  10 , Henrik Morville Schrøder  11 , Martin Lindberg-Larsen  12   13 , Anders Kehlet Nørskov  14   15 , Kasper Højgaard Thybo  7 , Stig Brorson  2   16 , Søren Overgaard  2   8   12   13 , Janus Christian Jakobsen  3   15 , Ole Mathiesen  2   7
Affiliations
Randomized Controlled Trial

Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial

Kasper Smidt Gasbjerg et al. BMJ. .

Abstract

Objective: To investigate the effects of one and two doses of intravenous dexamethasone in patients after total knee arthroplasty.

Design: Randomised, blinded, placebo controlled trial with follow-up at 90 days.

Setting: Five Danish hospitals, September 2018 to March 2020.

Participants: 485 adult participants undergoing total knee arthroplasty.

Intervention: A computer generated randomised sequence stratified for site was used to allocate participants to one of three groups: DX1 (dexamethasone (24 mg)+placebo); DX2 (dexamethasone (24 mg)+dexamethasone (24 mg)); or placebo (placebo+placebo). The intervention was given preoperatively and after 24 hours. Participants, investigators, and outcome assessors were blinded. All participants received paracetamol, ibuprofen, and local infiltration analgesia.

Main outcome measures: The primary outcome was total intravenous morphine consumption 0 to 48 hours postoperatively. Multiplicity adjusted threshold for statistical significance was P<0.017 and minimal important difference was 10 mg morphine. Secondary outcomes included postoperative pain.

Results: 485 participants were randomised: 161 to DX1, 162 to DX2, and 162 to placebo. Data from 472 participants (97.3%) were included in the primary outcome analysis. The median (interquartile range) morphine consumptions at 0-48 hours were: DX1 37.9 mg (20.7 to 56.7); DX2 35.0 mg (20.6 to 52.0); and placebo 43.0 mg (28.7 to 64.0). Hodges-Lehmann median differences between groups were: -2.7 mg (98.3% confidence interval -9.3 to 3.7), P=0.30 between DX1 and DX2; 7.8 mg (0.7 to 14.7), P=0.008 between DX1 and placebo; and 10.7 mg (4.0 to 17.3), P<0.001 between DX2 and placebo. Postoperative pain was reduced at 24 hours with one dose, and at 48 hours with two doses, of dexamethasone.

Conclusion: Two doses of dexamethasone reduced morphine consumption during 48 hours after total knee arthroplasty and reduced postoperative pain.

Trial registration: Clinicaltrials.gov NCT03506789.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from Næstved, Slagelse, and Ringsted Hospitals’ Research Fund and the Department of Anaesthesiology at Næstved, Slagelse and Ringsted Hospitals for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Screening, randomisation, and primary outcome population
Fig 2
Fig 2
Distribution of morphine consumption according to group 0-48 hours postoperatively. Vertical dashed yellow lines indicate median level of morphine consumption. DX1=dexamethasone (24 mg)+placebo; DX2=dexamethasone (24 mg)+dexamethasone (24 mg); placebo=placebo+placebo
See this image and copyright information in PMC

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