Adding corticosteroids to periarticular infiltration analgesia improves the short-term analgesic effects after total knee arthroplasty: a prospective, double-blind, randomized controlled trial.
Aged
Analgesics
/ administration & dosage
Arthroplasty, Replacement, Knee
/ adverse effects
Dexamethasone
/ administration & dosage
Double-Blind Method
Epinephrine
/ administration & dosage
Female
Glucocorticoids
/ administration & dosage
Humans
Injections, Intra-Articular
Knee Joint
/ surgery
Male
Middle Aged
Morphine
/ administration & dosage
Pain Management
/ methods
Pain Measurement
Pain, Postoperative
/ etiology
Prospective Studies
Ropivacaine
/ administration & dosage
Visual Analog Scale
Analgesia
Corticosteroids
Pain
Periarticular infiltration
Total knee arthroplasty
Journal
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Titre abrégé: Knee Surg Sports Traumatol Arthrosc
Pays: Germany
ID NLM: 9314730
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
13
01
2020
accepted:
27
04
2020
pubmed:
4
5
2020
medline:
5
5
2021
entrez:
4
5
2020
Statut:
ppublish
Résumé
Periarticular infiltration analgesia (PIA) is widely used to control postoperative pain in patients who underwent total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of adding corticosteroids to the PIA cocktail for pain management in patients who underwent TKA. The patients were randomized to the corticosteroid or control group (double-blind). The patients in the corticosteroid group received a periarticular infiltration of an analgesic cocktail of ropivacaine, epinephrine, and dexamethasone. Dexamethasone was omitted from the cocktail in the control group. The primary outcomes were postoperative pain [assessed using a visual analog scale (VAS)], time until the administration of first rescue analgesia, morphine consumption, and postoperative inflammatory biomarkers [C-reactive protein (CRP) and interleukin-6 (IL-6)]. The secondary outcomes were functional recovery, assessed by the range of knee motion, quadriceps strength, and daily ambulation distance. The tertiary outcomes included postoperative adverse effects. The patients in the corticosteroid group had significantly lower resting VAS scores at 6 and 12 h after surgery, lower VAS scores during motion up to 24 h after surgery, and lower levels of inflammatory biomarkers. All the differences in the VAS scores between the two groups did not reach the point to be considered clinically significant. The additional use of corticosteroid significantly prolonged analgesic effects and led to lower rescue morphine consumption. The patients in the corticosteroid group had significantly better functional recovery on the first day after surgery. The two groups had a similar occurrence of adverse effects. Adding corticosteroids to an analgesic cocktail for PIA could lightly improve early pain relief and accelerate recovery in the first 24 h after TKA. Randomized controlled trial, Level I.
Identifiants
pubmed: 32361928
doi: 10.1007/s00167-020-06039-9
pii: 10.1007/s00167-020-06039-9
doi:
Substances chimiques
Analgesics
0
Glucocorticoids
0
Morphine
76I7G6D29C
Ropivacaine
7IO5LYA57N
Dexamethasone
7S5I7G3JQL
Epinephrine
YKH834O4BH
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
867-875Subventions
Organisme : Department of Science and Technology of Sichuan Province
ID : 2019YFS0123.
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