Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial
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Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial. / Gasbjerg, Kasper Smidt; Hägi-Pedersen, Daniel; Lunn, Troels Haxholdt; Laursen, Christina Cleveland; Holmqvist, Majken; Vinstrup, Louise Ørts; Ammitzboell, Mette; Jakobsen, Karina; Jensen, Mette Skov; Pallesen, Marie Jøhnk; Bagger, Jens; Lindholm, Peter; Pedersen, Niels Anker; Schrøder, Henrik Morville; Lindberg-Larsen, Martin; Nørskov, Anders Kehlet; Thybo, Kasper Højgaard; Brorson, Stig; Overgaard, Søren; Jakobsen, Janus Christian; Mathiesen, Ole.
In: BMJ, Vol. 376, e067325, 2022.Research output: Contribution to journal › Journal article › Research › peer-review
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T1 - Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial
AU - Gasbjerg, Kasper Smidt
AU - Hägi-Pedersen, Daniel
AU - Lunn, Troels Haxholdt
AU - Laursen, Christina Cleveland
AU - Holmqvist, Majken
AU - Vinstrup, Louise Ørts
AU - Ammitzboell, Mette
AU - Jakobsen, Karina
AU - Jensen, Mette Skov
AU - Pallesen, Marie Jøhnk
AU - Bagger, Jens
AU - Lindholm, Peter
AU - Pedersen, Niels Anker
AU - Schrøder, Henrik Morville
AU - Lindberg-Larsen, Martin
AU - Nørskov, Anders Kehlet
AU - Thybo, Kasper Højgaard
AU - Brorson, Stig
AU - Overgaard, Søren
AU - Jakobsen, Janus Christian
AU - Mathiesen, Ole
PY - 2022
Y1 - 2022
N2 - Objective To investigate the effects of one and two doses of intravenous dexamethasone in patients after total knee arthroplasty.Design Randomised, blinded, placebo controlled trial with follow-up at 90 days.Setting Five Danish hospitals, September 2018 to March 2020.Participants 485 adult participants undergoing total knee arthroplasty.Intervention A computer generated randomised sequence stratified for site was used to allocate participants to one of three groups: DX1 (dexamethasone (24 mg)+placebo); DX2 (dexamethasone (24 mg)+dexamethasone (24 mg)); or placebo (placebo+placebo). The intervention was given preoperatively and after 24 hours. Participants, investigators, and outcome assessors were blinded. All participants received paracetamol, ibuprofen, and local infiltration analgesia.Main outcome measures The primary outcome was total intravenous morphine consumption 0 to 48 hours postoperatively. Multiplicity adjusted threshold for statistical significance was P<0.017 and minimal important difference was 10 mg morphine. Secondary outcomes included postoperative pain.Results 485 participants were randomised: 161 to DX1, 162 to DX2, and 162 to placebo. Data from 472 participants (97.3%) were included in the primary outcome analysis. The median (interquartile range) morphine consumptions at 0-48 hours were: DX1 37.9 mg (20.7 to 56.7); DX2 35.0 mg (20.6 to 52.0); and placebo 43.0 mg (28.7 to 64.0). Hodges-Lehmann median differences between groups were: −2.7 mg (98.3% confidence interval −9.3 to 3.7), P=0.30 between DX1 and DX2; 7.8 mg (0.7 to 14.7), P=0.008 between DX1 and placebo; and 10.7 mg (4.0 to 17.3), P<0.001 between DX2 and placebo. Postoperative pain was reduced at 24 hours with one dose, and at 48 hours with two doses, of dexamethasone.Conclusion Two doses of dexamethasone reduced morphine consumption during 48 hours after total knee arthroplasty and reduced postoperative pain.
AB - Objective To investigate the effects of one and two doses of intravenous dexamethasone in patients after total knee arthroplasty.Design Randomised, blinded, placebo controlled trial with follow-up at 90 days.Setting Five Danish hospitals, September 2018 to March 2020.Participants 485 adult participants undergoing total knee arthroplasty.Intervention A computer generated randomised sequence stratified for site was used to allocate participants to one of three groups: DX1 (dexamethasone (24 mg)+placebo); DX2 (dexamethasone (24 mg)+dexamethasone (24 mg)); or placebo (placebo+placebo). The intervention was given preoperatively and after 24 hours. Participants, investigators, and outcome assessors were blinded. All participants received paracetamol, ibuprofen, and local infiltration analgesia.Main outcome measures The primary outcome was total intravenous morphine consumption 0 to 48 hours postoperatively. Multiplicity adjusted threshold for statistical significance was P<0.017 and minimal important difference was 10 mg morphine. Secondary outcomes included postoperative pain.Results 485 participants were randomised: 161 to DX1, 162 to DX2, and 162 to placebo. Data from 472 participants (97.3%) were included in the primary outcome analysis. The median (interquartile range) morphine consumptions at 0-48 hours were: DX1 37.9 mg (20.7 to 56.7); DX2 35.0 mg (20.6 to 52.0); and placebo 43.0 mg (28.7 to 64.0). Hodges-Lehmann median differences between groups were: −2.7 mg (98.3% confidence interval −9.3 to 3.7), P=0.30 between DX1 and DX2; 7.8 mg (0.7 to 14.7), P=0.008 between DX1 and placebo; and 10.7 mg (4.0 to 17.3), P<0.001 between DX2 and placebo. Postoperative pain was reduced at 24 hours with one dose, and at 48 hours with two doses, of dexamethasone.Conclusion Two doses of dexamethasone reduced morphine consumption during 48 hours after total knee arthroplasty and reduced postoperative pain.
U2 - 10.1136/bmj-2021-067325
DO - 10.1136/bmj-2021-067325
M3 - Journal article
C2 - 34983775
VL - 376
JO - The BMJ
JF - The BMJ
SN - 0959-8146
M1 - e067325
ER -
ID: 289311603