TY - JOUR
T1 - Preoperative High-Dose Methylprednisolone and Glycemic Control Early After Total Hip and Knee Arthroplasty
T2 - A Randomized, Double-Blind, Placebo-Controlled Trial
AU - Lindberg-Larsen, Viktoria
AU - Kehlet, Henrik
AU - Bagger, Jens
AU - Madsbad, Sten
PY - 2018
Y1 - 2018
N2 - BACKGROUND: To evaluate the effect of a single preoperative dose of 125 mg methylprednisolone (MP) on glycemic homeostasis early after fast-track total hip and knee arthroplasty. METHODS: One-hundred thirty-four patients undergoing elective unilateral total hip arthroplasty and total knee arthroplasty were randomized (1:1) to preoperative intravenous MP 125 mg (group MP) or isotonic saline intravenous (group C). All procedures were performed under spinal anesthesia, using a standardized multimodal analgesic regime. The primary outcome was the change in plasma glucose 2 hours postoperatively, and secondary outcomes included plasma C-peptide concentrations, homeostatic model assessment (HOMA), HOMA-IR (insulin resistance), and HOMA-B (β-cell function). Fasting blood samples were collected at baseline and 2, 6 (nonfasting), 24, and 48 hours after surgery with complete samples from 122 patients (group MP = 62, group C = 60) for analyses. RESULTS: MP patients had increased plasma glucose levels at 2 hours (adjusted mean [95% CI], 7.4 mmol L-1 [7.2-7.5] vs 6.0 mmol L-1 [5.9-6.2]; P = .023) and 6 hours (13.9 mmol L-1 [13.3-14.5] vs 8.4 mmol L-1 [7.8-9.0]; P < .001), and in plasma C-peptide 24 hours postoperatively (1675 pmol L-1 [1573-1778] vs 1248 pmol L-1 [1145-1351]; P < .001). An impaired insulin response was also observed in group MP as reflected by HOMA-B (P < .001). Additionally, HOMA-IR increased 24 hours postoperatively in group MP compared to group C (P < .001). Parameters were normalized 48 hours postoperatively. CONCLUSIONS: Preoperative administration of MP 125 mg resulted in a transient postoperative increase in plasma glucose and insulin resistance and impaired insulin secretion in response to hyperglycemia.
AB - BACKGROUND: To evaluate the effect of a single preoperative dose of 125 mg methylprednisolone (MP) on glycemic homeostasis early after fast-track total hip and knee arthroplasty. METHODS: One-hundred thirty-four patients undergoing elective unilateral total hip arthroplasty and total knee arthroplasty were randomized (1:1) to preoperative intravenous MP 125 mg (group MP) or isotonic saline intravenous (group C). All procedures were performed under spinal anesthesia, using a standardized multimodal analgesic regime. The primary outcome was the change in plasma glucose 2 hours postoperatively, and secondary outcomes included plasma C-peptide concentrations, homeostatic model assessment (HOMA), HOMA-IR (insulin resistance), and HOMA-B (β-cell function). Fasting blood samples were collected at baseline and 2, 6 (nonfasting), 24, and 48 hours after surgery with complete samples from 122 patients (group MP = 62, group C = 60) for analyses. RESULTS: MP patients had increased plasma glucose levels at 2 hours (adjusted mean [95% CI], 7.4 mmol L-1 [7.2-7.5] vs 6.0 mmol L-1 [5.9-6.2]; P = .023) and 6 hours (13.9 mmol L-1 [13.3-14.5] vs 8.4 mmol L-1 [7.8-9.0]; P < .001), and in plasma C-peptide 24 hours postoperatively (1675 pmol L-1 [1573-1778] vs 1248 pmol L-1 [1145-1351]; P < .001). An impaired insulin response was also observed in group MP as reflected by HOMA-B (P < .001). Additionally, HOMA-IR increased 24 hours postoperatively in group MP compared to group C (P < .001). Parameters were normalized 48 hours postoperatively. CONCLUSIONS: Preoperative administration of MP 125 mg resulted in a transient postoperative increase in plasma glucose and insulin resistance and impaired insulin secretion in response to hyperglycemia.
U2 - 10.1213/ANE.0000000000003591
DO - 10.1213/ANE.0000000000003591
M3 - Journal article
C2 - 29944516
SN - 0003-2999
VL - 127
SP - 906
EP - 913
JO - Anesthesia and Analgesia
JF - Anesthesia and Analgesia
IS - 4
ER -