Perioperative Corticosteroid Doseage

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.