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- Title
Effect of pre-operative methylprednisolone on orthostatic hypotension during early mobilization after total hip arthroplasty.
- Authors
Lindberg‐Larsen, V.; Petersen, P. B.; Jans, Ø.; Beck, T.; Kehlet, H.; Lindberg-Larsen, V
- Abstract
<bold>Background: </bold>Orthostatic hypotension (OH) and intolerance (OI) are common after total hip arthroplasty (THA) and may delay early mobilization. The pathology of OH and OI includes a dysregulated post-operative vasopressor response, by a hitherto unknown mechanism. We hypothesized that OI could be related to the inflammatory stress response which is inhibited by steroid administration. Consequently, this study evaluated the effect of a pre-operative high-dose methylprednisolone on OH and OI early after THA.<bold>Methods: </bold>Randomized, double-blind, placebo-controlled study in 59 patients undergoing elective unilateral THA with spinal anesthesia and a standardized multimodal analgesic regime. Patients were allocated (1 : 1) to pre-operative intravenous (IV) methylprednisolone (MP) 125 mg or isotonic saline (C). OH, OI and cardiovascular responses to sitting and standing were evaluated using a standardized mobilization protocol pre-operatively, 6, and 24 h after surgery. Systolic and diastolic arterial pressure and heart rate were measured non-invasively (Nexfin® ). The systemic inflammation was monitored by the C-reactive protein (CRP) response.<bold>Results: </bold>At 6 h post-operatively, 11 (38%) versus 11 (37%) patients had OH in group MP and group C, respectively (RR 1.02 (0.60 to 1.75; P = 1.00)), whereas OI was present in 9 (31%) versus 13 (43%) patients (RR 0.76 (0.42 to 1.36; P = 0.42)), respectively. At 24 h post-operatively, the prevalence of OH and OI did not differ between groups, though CRP levels were significantly reduced in group MP (P < 0.001).<bold>Conclusion: </bold>Pre-operative administration of 125 mg methylprednisolone IV did not reduce OH or OI compared with placebo despite a reduced inflammatory response.
- Subjects
ORTHOSTATIC hypotension; TOTAL hip replacement; ANESTHESIA; METHYLPREDNISOLONE; INFLAMMATION; C-reactive protein; COMPARATIVE studies; HEMODYNAMICS; RESEARCH methodology; MEDICAL cooperation; RESEARCH; EVALUATION research; BLIND experiment; PREOPERATIVE period; EARLY ambulation (Rehabilitation); THERAPEUTICS
- Publication
Acta Anaesthesiologica Scandinavica, 2018, Vol 62, Issue 7, p882
- ISSN
0001-5172
- Publication type
journal article
- DOI
10.1111/aas.13108