Application and research progress of dexamethasone in the perioperative period of joint arthroplasty and arthroscopic surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HAN Hui , PAN Enhao , GAO Shunzhao ,  LU Weijie

Department of Orthopedic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China;

Corresponding author：

LU Weijie, Email: 13902280296@139.com

Keywords：

Dexamethasone; joint arthroplasty; arthroscopic surgery; perioperative period

DOI：

10.7507/1002-1892.202212058

Video：

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Objective To review the application and research progress of dexamethasone in the perioperative period of joint arthroplasty and arthroscopic surgery. Methods The relevant domestic and foreign literature in recent years was extensively reviewed. The application status and therapeutic effect of dexamethasone in the perioperative period of joint arthroplasty and arthroscopic surgery were summarized. Results Studies have shown that intravenous administration of 10-24 mg dexamethasone before or/and within 24-48 hours after operation can reduce the incidence of nausea and vomiting, and reduce the consumption of opioids in patients after hip and knee arthroplasties with high safety. The duration of nerve block during arthroscopic surgery can be prolonged by perineural injecting local anesthetics and 4-8 mg dexamethasone, but the effect of postoperative analgesia is still controversial. Conclusion Dexamethasone is widely used in joint and sports medicine. It has the effects of analgesia, antiemetic, and prolonging the time of nerve block. In the future, high-quality clinical studies on the application of dexamethasone in shoulder, elbow, and ankle arthroplasties and arthroscopic surgery are needed, and more attention should be paid to the long-term safety of dexamethasone.

Citation： HAN Hui, PAN Enhao, GAO Shunzhao, LU Weijie. Application and research progress of dexamethasone in the perioperative period of joint arthroplasty and arthroscopic surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(3): 365-370. doi: 10.7507/1002-1892.202212058 Copy

1.	Iwakiri K, Minami Y, Ohta Y, et al. Effect of periarticular morphine injection for total knee arthroplasty: A randomized, double-blind trial. J Arthroplasty, 2017, 32(6): 1839-1844.
2.	Mayr HO, Stoehr A. Complications of knee arthroscopy. Orthopade, 2016, 45(1): 4-12.
3.	Canovas F, Dagneaux L. Quality of life after total knee arthroplasty. Orthop Traumatol Surg Res, 2018, 104(1S): S41-S46.
4.	Mensah-Nyagan AG, Meyer L, Schaeffer V, et al. Evidence for a key role of steroids in the modulation of pain. Psychoneuroendocrinology, 2009, 34 Suppl 1: S169-S177.
5.	Chu CC, Hsing CH, Shieh JP, et al. The cellular mechanisms of the antiemetic action of dexamethasone and related glucocorticoids against vomiting. Eur J Pharmacol, 2014, 722: 48-54.
6.	De Oliveira GS, Almeida MD, Benzon HT, et al. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology, 2011, 115(3): 575-588.
7.	Lunn TH, Kristensen BB, Andersen LØ, et al. Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial. Br J Anaesth, 2011, 106(2): 230-238.
8.	Sinner B. Perioperative dexamethasone. Anaesthesist, 2019, 68(10): 676-682.
9.	Martin JR, Jennings JM, Dennis DA. Morbid obesity and total knee arthroplasty: A growing problem. J Am Acad Orthop Surg, 2017, 25(3): 188-194.
10.	Fan Z, Ma J, Kuang M, et al. The efficacy of dexamethasone reducing postoperative pain and emesis after total knee arthroplasty: A systematic review and meta-analysis. Int J Surg, 2018, 52: 149-155.
11.	Gasbjerg KS, Hägi-Pedersen D, Lunn TH, et al. Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial. BMJ, 2022, 376: e067325. doi: 10.1136/bmj-2021-067325.
12.	Chan TCW, Cheung CW, Wong SSC, et al. Preoperative dexamethasone for pain relief after total knee arthroplasty: A randomised controlled trial. Eur J Anaesthesiol, 2020, 37(12): 1157-1167.
13.	Lei Y, Huang Z, Huang Q, et al. Dose optimization of intravenous dexamethasone for total knee arthroplasty: when two is not better than one. Arch Orthop Trauma Surg, 2022, 142(4): 665-672.
14.	Eckhard L, Jones T, Collins JE, et al. Increased postoperative dexamethasone and gabapentin reduces opioid consumption after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2019, 27(7): 2167-2172.
15.	El-Boghdadly K, Short AJ, Gandhi R, et al. Addition of dexamethasone to local infiltration analgesia in elective total knee arthroplasty: double-blind, randomized control trial. Reg Anesth Pain Med, 2021, 46(2): 130-136.
16.	Li D, Wang Q, Zhao X, et al. Comparison of intravenous and topical dexamethasone for total knee arthroplasty: A randomized double-blinded controlled study of effects on dexamethasone administration route and enhanced recovery. J Arthroplasty, 2021, 36(5): 1599-1606.
17.	Saini MK, Reddy NR, Reddy PJ, et al. The application of low-dose dexamethasone in total knee arthroplasty: finding out the best route and dosage schedule. Arch Orthop Trauma Surg, 2022. doi: 10.1007/s00402-022-04356-x.
18.	Vuorinen MA, Palanne RA, Mäkinen TJ, et al. Infection safety of dexamethasone in total hip and total knee arthroplasty: a study of eighteen thousand, eight hundred and seventy two operations. Int Orthop, 2019, 43(8): 1787-1792.
19.	Nurok M, Cheng J, Romeo GR, et al. Dexamethasone and perioperative blood glucose in patients undergoing total joint arthroplasty: A retrospective study. J Clin Anesth, 2017, 37: 116-122.
20.	Park HJ, Chang MJ, Kim TW, et al. Effects of intravenous dexamethasone on glycemic control in patients with type 2 diabetes mellitus after total knee arthroplasty. J Arthroplasty, 2021, 36(12): 3909-3914.
21.	Lei Y, Huang Z, Huang Q, et al. Repeat doses of dexamethasone up to 48 hours further reduce pain and inflammation after total hip arthroplasty: a randomized controlled trial. J Arthroplasty, 2020, 35(11): 3223-3229.
22.	Lei Y, Huang Q, Xu B, et al. Multiple low-dose dexamethasone further improves clinical outcomes following total hip arthroplasty. J Arthroplasty, 2018, 33(5): 1426-1431.
23.	Lucero CM, Garcia-Mansilla A, Zanotti G et al. A repeat dose of perioperative dexamethasone can effectively reduce pain, opioid requirement, time to ambulation, and in-hospital stay after total hip arthroplasty: a prospective randomized controlled trial. J Arthroplasty, 2021, 36(12): 3938-3944.
24.	Lei Y, Huang Z, Huang Q, et al. Is a split-dose intravenous dexamethasone regimen superior to a single high dose in reducing pain and improving function after total hip arthroplasty? A randomized blinded placebo-controlled trial. Bone Joint J, 2020, 102-B(11): 1497-1504.
25.	El-Boghdadly K, Short AJ, Gandhi R, et al. Addition of dexamethasone to local infiltration analgesia in elective total hip arthroplasty: a double-blind, randomized control trial. Reg Anesth Pain Med, 2019, 46(2): 130-136.
26.	Lei YT, Xu B, Xie XW, et al. The efficacy and safety of two low-dose peri-operative dexamethasone on pain and recovery following total hip arthroplasty: a randomized controlled trial. Int Orthop, 2018, 42(3): 499-505.
27.	Klement MR, Wilkens HS, Fillingham YA, et al. Intraoperative dexamethasone reduces readmission rates without affecting risk of thromboembolic events or infection after total joint arthroplasty. J Arthroplasty, 2018, 33(10): 3252-3256.
28.	Klag EA, Kuhlmann NA, Tramer JS, et al. Dexamethasone decreases postoperative opioid and antiemetic use in shoulder arthroplasty patients: a prospective, randomized controlled trial. J Shoulder Elbow Surg, 2021, 30(7): 1544-1552.
29.	Routman HD, Israel LR, Moor MA, et al. Local injection of liposomal bupivacaine combined with intravenous dexamethasone reduces postoperative pain and hospital stay after shoulder arthroplasty. J Shoulder Elbow Surg, 2017, 26(4): 641-647.
30.	Moeen SM, Ramadan IK, Elkady HA. Dexamethasone and dexmedetomidine as an adjuvant to intraarticular bupivacaine for postoperative pain relief in knee arthroscopic surgery: a randomized trial. Pain Physician, 2017, 20(7): 671-680.
31.	Moyano J, Garcia M, Caicedo M. Analgesic effect of dexamethasone after arthroscopic knee surgery: a randomized controlled trial. Pain Res Manag, 2016, 2016: 4216469. doi: 10.1155/2016/4216469.
32.	Ibrahim AS, Aly MG, Farrag WS, et al. Ultrasound-guided adductor canal block after arthroscopic anterior cruciate ligament reconstruction: Effect of adding dexamethasone to bupivacaine, a randomized controlled trial. Eur J Pain, 2019, 23(1): 135-141.
33.	Aoyama Y, Sakura S, Abe S, et al. Effects of the addition of dexamethasone on postoperative analgesia after anterior cruciate ligament reconstruction surgery under quadruple nerve blocks. BMC Anesthesiol, 2021, 21(1): 218. doi: 10.1186/s12871-021-01440-4.
34.	Veneziano G, Martin DP, Beltran R, et al. Dexamethasone as an adjuvant to femoral nerve block in children and adolescents undergoing knee arthroscopy: a prospective, randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med, 2018, 43(4): 438-444.
35.	Holland D, Amadeo RJJ, Wolfe S, et al. Effect of dexamethasone dose and route on the duration of interscalene brachial plexus block for outpatient arthroscopic shoulder surgery: a randomized controlled trial. Can J Anaesth, 2018, 65(1): 34-45.
36.	Kang RA, Jeong JS, Yoo JC, et al. Improvement in postoperative pain control by combined use of intravenous dexamethasone with intravenous dexmedetomidine after interscalene brachial plexus block for arthroscopic shoulder surgery: A randomised controlled trial. Eur J Anaesthesiol, 2019, 36(5): 360-368.

1. Iwakiri K, Minami Y, Ohta Y, et al. Effect of periarticular morphine injection for total knee arthroplasty: A randomized, double-blind trial. J Arthroplasty, 2017, 32(6): 1839-1844.
2. Mayr HO, Stoehr A. Complications of knee arthroscopy. Orthopade, 2016, 45(1): 4-12.
3. Canovas F, Dagneaux L. Quality of life after total knee arthroplasty. Orthop Traumatol Surg Res, 2018, 104(1S): S41-S46.
4. Mensah-Nyagan AG, Meyer L, Schaeffer V, et al. Evidence for a key role of steroids in the modulation of pain. Psychoneuroendocrinology, 2009, 34 Suppl 1: S169-S177.
5. Chu CC, Hsing CH, Shieh JP, et al. The cellular mechanisms of the antiemetic action of dexamethasone and related glucocorticoids against vomiting. Eur J Pharmacol, 2014, 722: 48-54.
6. De Oliveira GS, Almeida MD, Benzon HT, et al. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology, 2011, 115(3): 575-588.
7. Lunn TH, Kristensen BB, Andersen LØ, et al. Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial. Br J Anaesth, 2011, 106(2): 230-238.
8. Sinner B. Perioperative dexamethasone. Anaesthesist, 2019, 68(10): 676-682.
9. Martin JR, Jennings JM, Dennis DA. Morbid obesity and total knee arthroplasty: A growing problem. J Am Acad Orthop Surg, 2017, 25(3): 188-194.
10. Fan Z, Ma J, Kuang M, et al. The efficacy of dexamethasone reducing postoperative pain and emesis after total knee arthroplasty: A systematic review and meta-analysis. Int J Surg, 2018, 52: 149-155.
11. Gasbjerg KS, Hägi-Pedersen D, Lunn TH, et al. Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial. BMJ, 2022, 376: e067325. doi: 10.1136/bmj-2021-067325.
12. Chan TCW, Cheung CW, Wong SSC, et al. Preoperative dexamethasone for pain relief after total knee arthroplasty: A randomised controlled trial. Eur J Anaesthesiol, 2020, 37(12): 1157-1167.
13. Lei Y, Huang Z, Huang Q, et al. Dose optimization of intravenous dexamethasone for total knee arthroplasty: when two is not better than one. Arch Orthop Trauma Surg, 2022, 142(4): 665-672.
14. Eckhard L, Jones T, Collins JE, et al. Increased postoperative dexamethasone and gabapentin reduces opioid consumption after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2019, 27(7): 2167-2172.
15. El-Boghdadly K, Short AJ, Gandhi R, et al. Addition of dexamethasone to local infiltration analgesia in elective total knee arthroplasty: double-blind, randomized control trial. Reg Anesth Pain Med, 2021, 46(2): 130-136.
16. Li D, Wang Q, Zhao X, et al. Comparison of intravenous and topical dexamethasone for total knee arthroplasty: A randomized double-blinded controlled study of effects on dexamethasone administration route and enhanced recovery. J Arthroplasty, 2021, 36(5): 1599-1606.
17. Saini MK, Reddy NR, Reddy PJ, et al. The application of low-dose dexamethasone in total knee arthroplasty: finding out the best route and dosage schedule. Arch Orthop Trauma Surg, 2022. doi: 10.1007/s00402-022-04356-x.
18. Vuorinen MA, Palanne RA, Mäkinen TJ, et al. Infection safety of dexamethasone in total hip and total knee arthroplasty: a study of eighteen thousand, eight hundred and seventy two operations. Int Orthop, 2019, 43(8): 1787-1792.
19. Nurok M, Cheng J, Romeo GR, et al. Dexamethasone and perioperative blood glucose in patients undergoing total joint arthroplasty: A retrospective study. J Clin Anesth, 2017, 37: 116-122.
20. Park HJ, Chang MJ, Kim TW, et al. Effects of intravenous dexamethasone on glycemic control in patients with type 2 diabetes mellitus after total knee arthroplasty. J Arthroplasty, 2021, 36(12): 3909-3914.
21. Lei Y, Huang Z, Huang Q, et al. Repeat doses of dexamethasone up to 48 hours further reduce pain and inflammation after total hip arthroplasty: a randomized controlled trial. J Arthroplasty, 2020, 35(11): 3223-3229.
22. Lei Y, Huang Q, Xu B, et al. Multiple low-dose dexamethasone further improves clinical outcomes following total hip arthroplasty. J Arthroplasty, 2018, 33(5): 1426-1431.
23. Lucero CM, Garcia-Mansilla A, Zanotti G et al. A repeat dose of perioperative dexamethasone can effectively reduce pain, opioid requirement, time to ambulation, and in-hospital stay after total hip arthroplasty: a prospective randomized controlled trial. J Arthroplasty, 2021, 36(12): 3938-3944.
24. Lei Y, Huang Z, Huang Q, et al. Is a split-dose intravenous dexamethasone regimen superior to a single high dose in reducing pain and improving function after total hip arthroplasty? A randomized blinded placebo-controlled trial. Bone Joint J, 2020, 102-B(11): 1497-1504.
25. El-Boghdadly K, Short AJ, Gandhi R, et al. Addition of dexamethasone to local infiltration analgesia in elective total hip arthroplasty: a double-blind, randomized control trial. Reg Anesth Pain Med, 2019, 46(2): 130-136.
26. Lei YT, Xu B, Xie XW, et al. The efficacy and safety of two low-dose peri-operative dexamethasone on pain and recovery following total hip arthroplasty: a randomized controlled trial. Int Orthop, 2018, 42(3): 499-505.
27. Klement MR, Wilkens HS, Fillingham YA, et al. Intraoperative dexamethasone reduces readmission rates without affecting risk of thromboembolic events or infection after total joint arthroplasty. J Arthroplasty, 2018, 33(10): 3252-3256.
28. Klag EA, Kuhlmann NA, Tramer JS, et al. Dexamethasone decreases postoperative opioid and antiemetic use in shoulder arthroplasty patients: a prospective, randomized controlled trial. J Shoulder Elbow Surg, 2021, 30(7): 1544-1552.
29. Routman HD, Israel LR, Moor MA, et al. Local injection of liposomal bupivacaine combined with intravenous dexamethasone reduces postoperative pain and hospital stay after shoulder arthroplasty. J Shoulder Elbow Surg, 2017, 26(4): 641-647.
30. Moeen SM, Ramadan IK, Elkady HA. Dexamethasone and dexmedetomidine as an adjuvant to intraarticular bupivacaine for postoperative pain relief in knee arthroscopic surgery: a randomized trial. Pain Physician, 2017, 20(7): 671-680.
31. Moyano J, Garcia M, Caicedo M. Analgesic effect of dexamethasone after arthroscopic knee surgery: a randomized controlled trial. Pain Res Manag, 2016, 2016: 4216469. doi: 10.1155/2016/4216469.
32. Ibrahim AS, Aly MG, Farrag WS, et al. Ultrasound-guided adductor canal block after arthroscopic anterior cruciate ligament reconstruction: Effect of adding dexamethasone to bupivacaine, a randomized controlled trial. Eur J Pain, 2019, 23(1): 135-141.
33. Aoyama Y, Sakura S, Abe S, et al. Effects of the addition of dexamethasone on postoperative analgesia after anterior cruciate ligament reconstruction surgery under quadruple nerve blocks. BMC Anesthesiol, 2021, 21(1): 218. doi: 10.1186/s12871-021-01440-4.
34. Veneziano G, Martin DP, Beltran R, et al. Dexamethasone as an adjuvant to femoral nerve block in children and adolescents undergoing knee arthroscopy: a prospective, randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med, 2018, 43(4): 438-444.
35. Holland D, Amadeo RJJ, Wolfe S, et al. Effect of dexamethasone dose and route on the duration of interscalene brachial plexus block for outpatient arthroscopic shoulder surgery: a randomized controlled trial. Can J Anaesth, 2018, 65(1): 34-45.
36. Kang RA, Jeong JS, Yoo JC, et al. Improvement in postoperative pain control by combined use of intravenous dexamethasone with intravenous dexmedetomidine after interscalene brachial plexus block for arthroscopic shoulder surgery: A randomised controlled trial. Eur J Anaesthesiol, 2019, 36(5): 360-368.

Chinese Journal of Reparative and Reconstructive Surgery

Application and research progress of dexamethasone in the perioperative period of joint arthroplasty and arthroscopic surgery

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