Perioperative IV Dexamethasone Decreased Opioid Consumption After Total Knee Arthroplasty

A systematic review and meta-analysis published in Pain Physician found that perioperative intravenous dexamethasone reduced pain, opioid consumption, and length of hospital stay among patients undergoing total knee arthroplasty (TKA).

Investigators at Central South University in China searched publication databases through August 2021 for studies of perioperative dexamethasone use in TKA. The primary outcomes were postoperative pain scores at 24 and 48 hours and secondary outcomes were opioid consumption at 24 and 48 hours, length of hospital stay, and adverse events.

In total, 11 studies comprising 1671 patients were included. The patients received 8-20 mg dexamethasone intravenously, with repeat dosing allowed in 6 studies.

Dexamethasone associated with decreased pain scores at 24 hours at rest (mean difference [MD], -0.68; 95% CI, -0.87 to -0.49; P <.0001; I², 73%) and during movement (MD, -0.74; 95% CI, -1.10 to -0.37; P <.0001; I², 91%) and at 48 hours at rest (MD, -0.33; 95% CI, -0.46 to -0.21; P <.00001; I², 34%) and during movement (MD, -0.46; 95% CI, -0.66 to -0.26; P <.00001; I², 85%).

No differences in pain were observed among the patients who received 1 or 2 dexamethasone doses.

Three studies reported opioid consumption at 24 hours and 2 at 48 hours. Dexamethasone associated with lower opioid consumption at 24 hours (MD, -2.84; 95% CI, -5.13 to -0.54; P =.02; I², 52%) and 48 hours (MD, -4.16; 95% CI, -5.55 to -2.78; P <.00001; I², 93%). Fewer dexamethasone recipients required rescue analgesics (risk ratio [RR], 0.23; 95% CI, 0.16-0.35; P <.00001; I², 28%).

The length of stay in the hospital was shorter among dexamethasone recipients (MD, -0.13; 95% CI, -0.24 to -0.01; P =.03; I², 0%).

Dexamethasone did not associate with increased rates of infection (P =.78), intestinal hemorrhage (P =1), or wound healing problems (P =.63).

This analysis was limited by the significant study heterogeneity, in part due to the differing perioperative pain management plans in each study.

This study found evidence to support the use of perioperative intravenous dexamethasone to reduce postoperative pain, opioid consumption, and length of hospital stay following TKA.

Reference

Liang S, Xing M, Jiang S, Zou W. Effect of intravenous dexamethasone on postoperative pain in patients undergoing total knee arthroplasty: A systematic review and meta-analysis. Pain Physician. 2022;25(2):E169-E183