| acute pain management

Knee Arthroplasty & Dexamethasone

A Safe Option

Post outpatient surgery for joint replacement, what are the benefits and/or drawbacks of sending a patient home with dexamethasone pills for pain? Over 100 patients at an institution received either dexamethasone or placebo for 4 days after a total knee arthroplasty. Pain scores for postoperative days 1-7 and postoperative side effects were the primary and secondary outcome measures, respectively. Complications included opioid use, help needed for ambulating, sleep issues, and nausea/vomiting. Results included for the dexamethasone vs placebo patients:

  • Statistically significant decrease in VAS scores
  • Less, but not statistically significant, oxycodone usage
  • No difference in complications

Lead investigator Jonathan Shaw, MD, commented, "When it comes to supporting our same-day joint replacement patients at ambulatory surgical centers, our research focus has been how to properly manage pain when they go home in order to reduce the use of opioids as well as unnecessary emergency department visits.” Dr. Shaw is chief resident, Department of Orthopedic Surgery at Henry Ford Health. The study concluded this "trial demonstrated that oral dexamethasone following primary total knee arthroplasty reduces pain scores postoperatively when added to a multimodal pain control regimen. This stands as a beneficial and safe option in ambulatory surgery where patients are unable to receive the traditional postoperative intravenous dose of dexamethasone.”


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