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ANALGESIA

Single-Dose Dexamethasone Reduces Dynamic Pain After Total Hip Arthroplasty

Kenneth J. Kardash, MD^*, Frederic Sarrazin, BEng, MD^*, Michael J. Tessler, MD^*, and Ana M. Velly, DDS, PhD

From the *Department of Anesthesia and Center of Clinical Epidemiology and Community Studies, Sir Mortimer B Davis-Jewish General Hospital, McGill University, Montreal, Canada; and Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, Minnesota.

Address correspondence to Kenneth Kardash, MD, Department of Anesthesia, SMBD-Jewish General Hospital, 3755 Cote Ste. Catherine Road, Montreal, Quebec, Canada H3T 1E2. Address e-mail to kenneth.kardash{at}mcgill.ca.

Abstract

BACKGROUND: Preoperative glucocorticoids reduce postoperative nausea but may also improve analgesia and decrease opioid consumption.

METHODS: Fifty consecutive patients undergoing elective, unilateral, primary total hip arthroplasty under spinal anesthesia with propofol sedation received in a randomized, double-blind, placebo-controlled manner either 40 mg of dexamethasone or saline placebo IV before the start of surgery. IV patient-controlled analgesia morphine, ibuprofen 400 mg po q6 h and acetaminophen 650 mg po q6 h were given for 48 h. Pain (0–10 numeric rating scale, NRS) at rest, side effects, and total cumulative patient-controlled analgesia morphine consumption were recorded q4 h for 48 h. Dynamic pain NRS score was recorded at 24 h. C-reactive protein levels were measured in a subgroup of 25 patients at 48 h.

RESULTS: The intraoperative sedation requirement with propofol was significantly increased in the dexamethasone group (234.6 ± 160.1 vs 138.8 ± 122.7 mg, P = 0.02). Dynamic pain was greatly reduced in the dexamethasone group (NRS score: 2.7, 95% CI: 2.2–3.1 vs 6.8, 6.4–7.2; P < 0.0001). There was no significant effect on pain at rest or cumulative morphine consumption at any time. C-reactive protein levels at 48 h were markedly reduced by dexamethasone (52.4 mg/mL, 28.2–76.6 vs 194.2, 168.9–219.4; P < 0.0001). Seven patients in the control group, but only one in the dexamethasone group, were treated for nausea (P = 0.05).

CONCLUSIONS: A single, preoperative IV dose of dexamethasone 40 mg has a prolonged suppressive effect on the inflammatory response and decreases dynamic pain 24 h after total hip arthroplasty.

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