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Addition of dexamethasone to local infiltration analgesia in elective total hip arthroplasty: a double-blind, randomized control trial
  1. Kariem El-Boghdadly1,2,
  2. Anthony James Short3,
  3. Rajiv Gandhi4 and
  4. Vincent W S Chan5
  1. 1Department of Anaesthesia, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  2. 2King’s College London, London, UK
  3. 3Department of Anaesthetics, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
  4. 4Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  5. 5Anesthesia, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Kariem El-Boghdadly, Department of Anaesthesia, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK; elboghdadly{at}gmail.com

Abstract

Background and objectives Pain following total hip arthroplasty is significant, and effective analgesia is associated with an improvement in functional outcomes. Dexamethasone may facilitate the action of local anesthesia, but its role as an additive to a local infiltration analgesia (LIA) mixture in hip arthroplasty settings has not been investigated. We hypothesized that the addition of dexamethasone to local anesthetic infiltration improves analgesic outcomes following total hip arthroplasty.

Methods We performed a double-blind, randomized control trial of 170 patients undergoing total hip arthroplasty. Patients were randomized to receive LIA mixed with either 2 mL of saline 0.9% or 2 mL of dexamethasone 4 mg/mL. The primary outcome was 24 hours oral morphine consumption. Secondary outcomes included short-term and long-term analgesic and functional outcomes and adverse events.

Results 85 patients were included in each arm. 24 hours morphine consumption was similar between saline and dexamethasone groups, with a median (IQR (range)) of 75 (45–105 (0–240)) and 62.5 (37.5–102.5 (0–210)) mg, respectively (p=0.145). However, patients receiving dexamethasone had significantly reduced opioid consumption for their total in-hospital stay, but not at any other time points examined. Functional outcomes were similar between groups. The incidence of postoperative nausea and vomiting was reduced in patients receiving dexamethasone.

Conclusions The addition of 8 mg dexamethasone to LIA did not reduce 24 hours morphine consumption but was associated with limited improvement in short-term analgesic outcomes and a reduction in postoperative nausea and vomiting. Dexamethasone had no effect on functional outcomes or long-term analgesia.

Trial registration number NCT02760043

  • Hip surgery
  • dexamethasone
  • regional anesthesia
  • orthopedics
  • local anaesthesia
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Footnotes

  • Twitter @elboghdadly, @tony_short

  • Contributors Study design: KE-B, AJS, RG, and VWSC. Study conduct: KE-B, RG, and VWSC. Data analysis: KE-B, AJS, and VWSC. Manuscript preparation: KE-B. Manuscript revision: KE-B, AJS, RG, and VWSC. Manuscript approval: KE-B, AJS, RG, and VWSC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This trial was approved by the University Health Network Research and Ethics Board (15-9898-A).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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