Implication of Preoperative Intravenous Dexamethasone on Pain and Nausea in Late-Stage Elderly Total Knee Arthroplasty Patients: A Randomized Double-Blind Trial.

Abstract

Total knee arthroplasty (TKA) is a standard procedure in elderly patients; however, postoperative pain and postoperative nausea and vomiting (PONV) remain challenging. This study aimed to evaluate the effects of a single preoperative intravenous (IV) dose of dexamethasone (10 mg) on postoperative pain and PONV in older patients (≥ 75 years) undergoing TKA. A single-center, double-blind, two-arm study compared preoperative dexamethasone (10 mg) versus saline on postoperative pain and PONV in planned TKA patients over 75 years old. Subjects received multimodal analgesia, including femoral nerve block, cyclooxygenase inhibitors, local anesthetic infiltration, and patient-controlled IV analgesia with opioids. The primary outcomes were resting numeric rating scale score and incidence of PONV at 24 hours. Secondary outcomes included motion pain scores, opioid consumption, nausea severity, blood glucose, inflammatory factors, and side effects. There were 160 patients randomized; 153 completed the allocated interventions (dexamethasone n = 77, control n = 76). At 24 hours postoperatively, the dexamethasone group had a lower median resting numeric rating scale score (4 interquartile range 3 to 4] versus 5 [interquartile range 4 to 6], P < 0.001) and a lower incidence of PONV (16.9 versus 40.8%, P = 0.002) compared with controls. Select secondary outcomes showed significantly lower motion pain scores (24 hours, 36 hours, and one week) and reduced serum interleukin-6 and C-reactive protein levels in the dexamethasone group (all P < 0.05). No significant difference was noted in total opioid consumption, rescue analgesics, or incidence of infection and delayed wound healing between groups. Preoperative administration of 10 mg IV dexamethasone to relatively healthy late-stage elderly patients (American Society of Anesthesiologists Physical Status I to II) undergoing TKA significantly reduced postoperative pain and PONV without increasing wound complications or infections. However, caution should be exercised when extrapolating these results to more comorbid populations, and further research is needed to assess long-term outcomes and broader applicability.