A Randomized, Double-Blind, Placebo-Controlled Trial on the Efficacy of Dexamethasone Combined With Neuraxial Anesthesia in Reducing Pain and Opioid Consumption After Primary Cementless Total Hip Arthroplasty Using the Direct Anterior Approach.

Abstract

High-dose intravenous glucocorticoids are increasingly recognized for reducing postoperative pain, nausea, and opioid use in total hip arthroplasty (THA) and total knee arthroplasty. However, randomized studies assessing intraoperative dexamethasone versus placebo under neuraxial anesthesia (NA) are limited. A total of 90 patients undergoing THA via the direct anterior approach under NA were randomized to receive either a single 10 milligrams intravenous dose of dexamethasone or placebo (isotonic saline). Demographics were similar between groups. Both groups followed identical perioperative anesthesia protocols. The primary outcomes included postoperative pain (visual analog scale), opioid use (morphine milligram equivalents), and range of motion at 24 hours. The secondary outcomes were the Timed Up and Go test and in-hospital complications. The MMEs were significantly reduced in the dexamethasone group compared to placebo (6.4 ± 12.8 versus 16.9 ± 24.7, P = 0.01). The visual analog scale scores were lower in the dexamethasone group at 6 and 12 hours postoperatively (2.2 ± 1.8 versus 3.0 ± 2.2, P = 0.05; 2.7 ± 2.0 versus 3.7 ± 2.4, P = 0.03), though the 1-hour score was higher in the dexamethasone group (0.8 ± 1.5 versus 0.2 ± 0.7, P = 0.02). There were no significant differences observed in range of motion or Timed Up and Go results. There were no complications related to dexamethasone reported. Intraoperative dexamethasone may reduce opioid use and early postoperative pain in THA under NA, supporting its role in enhanced recovery. While statistical significance was limited, the opioid-sparing effect and favorable safety profile suggest potential utility in multimodal analgesia. Further studies are needed to optimize dosing and confirm clinical benefits.