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Multicenter Study
. 2024 Jan;68(1):35-42.
doi: 10.1111/aas.14319. Epub 2023 Sep 14.

Prolonged effects of dexamethasone following total knee arthroplasty: A pre-planned sub-study of the DEX-2-TKA trial

Cecilie Bauer Derby  1 , Kasper Smidt Gasbjerg  2 , Daniel Hägi-Pedersen  2   3 , Troels Haxholdt Lunn  3   4 , Niels Anker Pedersen  5 , Peter Lindholm  6 , Stig Brorson  3   7 , Henrik Morville Schrøder  8 , Kasper Højgaard Thybo  1 , Jens Bagger  9 , Martin Lindberg-Larsen  10   11 , Søren Overgaard  3   9   10   11 , Janus Christian Jakobsen  12   13 , Ole Mathiesen  1   3
Affiliations
Multicenter Study

Prolonged effects of dexamethasone following total knee arthroplasty: A pre-planned sub-study of the DEX-2-TKA trial

Cecilie Bauer Derby et al. Acta Anaesthesiol Scand. 2024 Jan.

Abstract

Objectives: The DEX-2-TKA trial demonstrated that one and two doses of 24 mg intravenous dexamethasone reduced opioid consumption and pain after total knee arthroplasty (TKA). We aimed to investigate the prolonged effects of dexamethasone after the 48-h intervention period.

Design: This was a prospective, pre-planned questionnaire follow-up on postoperative days 3-7 of patients in the DEX-2-TKA trial that randomly received: DX1 (dexamethasone 24 mg + placebo), DX2 (dexamethasone 24 mg + dexamethasone 24 mg), and placebo (placebo + placebo) perioperatively and 24 h later.

Setting: A multicenter trial performed at five Danish hospitals.

Participants: We analyzed 434 of 485 adult participants enrolled in the DEX-2-TKA trial.

Outcome measures: Primary outcome was difference between groups in average of all numerical rating scale (NRS) pain scores reported in the morning, at bedtime, and the daily average pain on postoperative days 3-7. Secondary outcomes were sleep quality and patient satisfaction.

Results: The median (interquartile range) pain intensity levels for postoperative days 3-7 were: DX2 3.2 (2.1-4.3); DX1 3.3 (2.3-4.1); and placebo 3.3 (2.5-4.7). Hodges-Lehmann median differences between groups were: 0 (95% confidence interval - 0.54 to 0.2), P = 0.38 between DX1 and placebo; 0.1 (-0.47 to 0.33), p = .87 between DX1 and DX2; and 0.1 (-0.6 to 0.13), p = .20 between DX2 and placebo. We found no relevant differences between groups on sleep quality on postoperative days 3-7 nor for patient satisfaction with the analgesic treatment.

Conclusions: We found that neither one nor two doses of 24 mg intravenous dexamethasone demonstrated prolonged effects on overall pain or sleep quality on postoperative days 3-7 after total knee arthroplasty. We also found that dexamethasone had no effect on patient satisfaction.

Trial registration number: Clinicaltrials.gov NCT03506789 (main result trial).

Keywords: dexamethasone; pain; total knee arthroplasty.

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References

REFERENCES

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    1. Karlsen APH, Wetterslev M, Hansen SE, Hansen MS, Mathiesen O, Dahl JB. Postoperative pain treatment after Total knee arthroplasty: a systematic review. PLoS One. 2017;12:e0173107.
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    1. Gasbjerg KS, Hägi-Pedersen D, Lunn TH, et al. DEX-2-TKA-DEXamethasone twice for pain treatment after total knee arthroplasty: a protocol for a randomized, blinded, three-group multicentre clinical trial. Acta Anaesthesiol Scand. 2020;64:267-275.

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