One high quality study and one moderate quality study evaluated the impact of dosing of perioperative intravenous dexamethasone on opioid consumption and pain after TJA.[3,14] Turner et al. compared 8 mg intravenous dexamethasone (e.g. high dose) versus 4 mg intravenous dexamethasone (e.g. low dose) following a psoas block prior to primary total hip arthroplasty (THA).[3] The authors found no difference in postoperative pain or opioid consumption between the two different dexamethasone doses.[3] Kim et al. compared postoperative intravenous dexamethasone at 0.2 mg/kg versus 0.1 mg/kg for 24 hours after primary total knee arthroplasty (TKA) and found no difference in postoperative opioid consumption or postoperative pain at 2 days postoperatively.[14] Only Kim et al. evaluated postoperative nausea after TKA and found no difference between high and low dose intravenous dexamethasone.[14] While one high and one moderate quality study are sufficient to make a moderate recommendation, the workgroup downgraded the recommendation to limited as they believe that the data in these two studies alone are insufficient to make a definitive recommendation regarding the dose of corticosteroids that should be administered prior to primary TJA.
- Turner JD, Dobson SW, Weller RS, Russell GB, Henshaw DS. Intravenous dexamethasone fails to prolong psoas compartment block when assessed by objective pinprick sensory testing: a prospective, randomised, dose-dependent, placebo-controlled equivalency trial. Brit J Anaesth 2018;120:308–16. https://doi.org/10.1016/j.bja.2017.11.073.
- Kim J-K, Ro DH, Lee H-J, Park J-Y, Han H-S, Lee MC. Efficacy of Systemic Steroid Use Given One Day after Total Knee Arthroplasty for Pain and Nausea: A Randomized Controlled Study. J Arthroplast 2019;35:69–75. https://doi.org/10.1016/j.arth.2019.08.026.