TY - JOUR
T1 - Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial
AU - Lunn, Troels
AU - Kristensen, Billy Bjarne
AU - Andersen, Lasse
AU - Husted, H
AU - Otte, K S
AU - Gaarn-Larsen, L
AU - Kehlet, H
AU - Otte, Niels Kristian Stahl
AU - Kehlet, Henrik
PY - 2011/2
Y1 - 2011/2
N2 - Background: Total knee arthroplasty (TKA) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach, but the effect of high-dose glucocorticoid administration has not been studied.MethodsForty-eight patients undergoing unilateral TKA were included in a randomized, double-blind, placebo-controlled trial receiving preoperative methylprednisolone (MP) 125 mg i.v. or saline. All surgery was performed under lumbar spinal anaesthesia and patients received a standardized, multimodal analgesic regime. The primary endpoint was pain during walking 24 h after surgery, and secondary endpoints were pain at rest, pain upon hip flexion, and pain upon knee flexion. Pain assessments were performed repeatedly for the first 48 h after surgery, in a questionnaire from days 2 to 10, and at follow-up on days 21 and 30. Tertiary endpoints were postoperative nausea and vomiting (PONV), plasma C-reactive protein (CRP) concentrations, fatigue, sleep quality, and rescue analgesic and antiemetic requirements.ResultsPain during walking was significantly lower in the MP group up to 32 h after operation. Overall pain and cumulative pain scores (248 h) were lower for all pain assessments (P<0.04). Consumption of rescue oxycodone was lower from 0 to 24 h (P0.02) and PONV, consumption of ondansetron reduced (P<0.05), and CRP concentrations were lower at 24 h (P<0.000001). Fatigue throughout the day of surgery was lower (P0.02), but sleep quality was worse on the first night (P0.002). No side-effects or complications were observed in other respects.ConclusionsMP 125 mg before surgery improves analgesia and immediate recovery after TKA, even when combined with a multimodal analgesic regime. These findings call for further studies on safety aspects.
AB - Background: Total knee arthroplasty (TKA) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach, but the effect of high-dose glucocorticoid administration has not been studied.MethodsForty-eight patients undergoing unilateral TKA were included in a randomized, double-blind, placebo-controlled trial receiving preoperative methylprednisolone (MP) 125 mg i.v. or saline. All surgery was performed under lumbar spinal anaesthesia and patients received a standardized, multimodal analgesic regime. The primary endpoint was pain during walking 24 h after surgery, and secondary endpoints were pain at rest, pain upon hip flexion, and pain upon knee flexion. Pain assessments were performed repeatedly for the first 48 h after surgery, in a questionnaire from days 2 to 10, and at follow-up on days 21 and 30. Tertiary endpoints were postoperative nausea and vomiting (PONV), plasma C-reactive protein (CRP) concentrations, fatigue, sleep quality, and rescue analgesic and antiemetic requirements.ResultsPain during walking was significantly lower in the MP group up to 32 h after operation. Overall pain and cumulative pain scores (248 h) were lower for all pain assessments (P<0.04). Consumption of rescue oxycodone was lower from 0 to 24 h (P0.02) and PONV, consumption of ondansetron reduced (P<0.05), and CRP concentrations were lower at 24 h (P<0.000001). Fatigue throughout the day of surgery was lower (P0.02), but sleep quality was worse on the first night (P0.002). No side-effects or complications were observed in other respects.ConclusionsMP 125 mg before surgery improves analgesia and immediate recovery after TKA, even when combined with a multimodal analgesic regime. These findings call for further studies on safety aspects.
U2 - http://dx.doi.org/10.1093/bja/aeq333
DO - http://dx.doi.org/10.1093/bja/aeq333
M3 - Journal article
SN - 0007-0912
VL - 106
SP - 230
EP - 238
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 2
ER -