Description
Background
There is an ongoing effort to minimize the use of opioids in perioperative management after total knee arthroplasty (TKA). The purpose of this study was to find out if dexamethasone alone could safely manage postoperative pain and postoperative nausea and vomiting (PONV) following TKA without the need of intravenous (IV) patient-controlled analgesia (PCA) and if additional administration of dexamethasone would provide further benefit in terms of perioperative management.
Methods
Among patients who underwent TKA for osteoarthritis between August 2020 and December 2022, 178 patients (182 knees) were included. These patients were divided into two groups: Dexa_2 & PCA group for two administrations of IV dexamethasone with the use of IV PCA; Dexa_3 & NoPCA group for three administrations of IV dexamethasone without IV PCA. From operative day to postoperative day (POD) 5, pain visual analogue score (VAS), rescue opioids consumption, episodes of PONV, antiemetics usage, and side effects of opioids such as urinary retention, constipation, dizziness, delirium, drowsiness, and pruritus were checked.
Results
There was no difference in pain VAS between the two groups during all six perioperative days. Rescue opioids consumption was lower in Dexa_2 & PCA group on operative day and POD 1. Total dosage of used opioids for six perioperative days was lower in Dexa_3 & NoPCA group. PONV and antiemetics usage were lower in Dexa_3 & NoPCA group on POD 1. Urinary retention occurred less in Dexa_3 & NoPCA group.
Conclusion
Dexamethasone helped control pain and PONV during the perioperative period safely without the need of IV PCA. Additional administration of dexamethasone on POD 2 seemed to have additional benefit but further studies are needed to determine how often it can be used without the risk of any complications.
