Two Perioperative Dexamethasone Doses May Reduce Opioid Use in Total Knee, Hip Arthroplasty

A second dose of dexamethasone during primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) was associated with decreased postoperative opioid consumption in the first 72 hours, according to findings from a retrospective cohort study published in The Journal of Arthroplasty.

Patients over 18 years of age who underwent primary THA (N=2256) or TKA (N=2078) at New York University Langone Health between May 2020 and October 2021 and received 1 or 2 doses of intravenous perioperative dexamethasone were included in the study. The patients in the TKA and THA groups were propensity matched in a 1:1 ratio between the patients who received 1 and 2 doses. The primary outcomes for this study were opioid consumption, postoperative Verbal Rating Scale (VRS) score for pain, and Activity Measure for Post-Acute Care (AM-PAC) functional scores.

The matched THA 1- (n=991) and 2- (n=991) dose cohorts had a mean age of 65 and 66 years; 57.9% and 57.3% were women; 70.1% and 72.5% were White; and they had mean BMIs of 29.7 and 29.7 kg/m², respectively. The matched TKA 1- (n=399) and 2- (n=399) dose cohorts had a mean age of 66 and 66 years; 65.9% and 61.2% were women; 61.2% and 63.2% were White; and they had mean BMIs of 32.6 and 32.6 kg/m², respectively.

Compared with those in the 1-dose group, recipients in the 2-dose dexamethasone group consumed fewer morphine milligram equivalents at 24-48 hours (percent difference, -33.2%; P =.003), at 48-72 hours (percent difference, -48.3%; P =.001) hours, and overall (percent difference, -10.7; P =.072) after THA; likewise, at 24-48 hours (percent difference, -33.0%; P =.007) and 48-72 hours (percent difference, -49.3%; P =.004) and overall (percent difference, -38.4%; P =.004) after TKA.

The patients who received 2 doses of dexamethasone during THA reported lower 12-hour interval VRS pain scores at 48 to 60 hours (percent difference, -10%; P =.025) and those who received 2 doses during TKA reported lower scores at 36 to 48 hours (percent difference, -1.8%; P =.021) and 48 to 60 hours (percent difference, -14.4%; P =.020) compared with the 1-dose groups.

Receiving 2 perioperative dexamethasone doses did not have a significant effect on functional outcomes compared with 1 dose.

Similarly, no differences in 90-day surgical outcomes were observed between groups, except that patients who received 2 dexamethasone doses during TKA had significantly shorter mean hospital stays (mean, 1.6 vs 1.9 days; P =.048) compared with the 1-dose recipients.

The limitations of this study included the retrospective design, and a focus on patient outcomes in the immediate postoperative period.

 “Although additional research is necessary to delineate the long-term safety and efficacy of two 10 mg perioperative dexamethasone doses compared to other perioperative dosages, our findings may be useful for current total joint arthroplasty programs aiming to optimize postoperative pain management and improve quality of care,” concluded the study authors.