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- Title
Preoperative high-dose Steroids in Total Knee and Hip Arthroplasty - Protocols for three randomized controlled trials.
- Authors
Nielsen, Niklas I.; Kehlet, Henrik; Gromov, Kirill; Troelsen, Anders; Husted, Henrik; Varnum, Claus; Kjærsgaard‐Andersen, Per; Rasmussen, Lasse E.; Mandøe, Hans; Foss, Nicolai B.; Kjaersgaard-Andersen, Per
- Abstract
<bold>Background: </bold>Patients undergoing total knee arthroplasty (TKA)/ total hip arthroplasty (THA) still experience moderate-severe postoperative pain despite optimized pain management regimes. The patients already on opioid treatment and pain catastrophizers (PCs) have a higher risk of postoperative pain. The use of preoperative intravenous high-dose glucocorticoids decreases postoperative pain after TKA and THA, but optimal dose is yet to be found, and the effect on subpopulations at high pain risk is unknown.<bold>Aim: </bold>To investigate the effect of a higher than previously used dose of glucocorticoids (dexamethasone (DXM)), administered intravenously before surgery, as part of standardized fast-track regimen, on postoperative pain in TKA/THA subgroups.<bold>Method: </bold>Three separate randomized, double-blinded, controlled trials were planned to compare a new higher dose DXM (1 mg/kg) to the earlier used high-dose DXM (0.3 mg/kg). Study 1: predicted Low Pain TKA; study 2: predicted High Pain Responder (HPR) TKA; study 3: predicted HPR THA. Predicted HPR groups consist of either PCs with PCS-score of ≥ 21 and/or history of ongoing opioid-treatment of 30 mg/day of morphine or equivalents > 30 days. In total, 408 patients were planned for inclusion (160 Low Pain TKA, 88 HPR TKA, 160 HPR THA).<bold>Primary Outcome: </bold>Pain upon ambulation in a 5-meter walk test 24 hours after surgery. Secondary outcomes include use of analgesics, rescue-opioids, antiemetics, cumulated pain, CRP, OR-SDS, QoR-15, quality of sleep, length of stay (LOS), reasons for hospitalization, readmission, morbidity, and mortality. Patients completed follow-up on day 90. Recruiting commenced February 2019 and is expected to finish in September 2020.
- Subjects
TOTAL hip replacement; TOTAL knee replacement; POSTOPERATIVE pain; PAIN management; STEROIDS
- Publication
Acta Anaesthesiologica Scandinavica, 2020, Vol 64, Issue 9, p1350
- ISSN
0001-5172
- Publication type
journal article
- DOI
10.1111/aas.13656