Prolonged effects of dexamethasone following total knee arthroplasty: A pre-planned sub-study of the DEX-2-TKA trial
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Prolonged effects of dexamethasone following total knee arthroplasty : A pre-planned sub-study of the DEX-2-TKA trial. / Derby, Cecilie Bauer; Gasbjerg, Kasper Smidt; Hägi-Pedersen, Daniel; Lunn, Troels Haxholdt; Pedersen, Niels Anker; Lindholm, Peter; Brorson, Stig; Schrøder, Henrik Morville; Thybo, Kasper Højgaard; Bagger, Jens; Lindberg-Larsen, Martin; Overgaard, Søren; Jakobsen, Janus Christian; Mathiesen, Ole.
In: Acta Anaesthesiologica Scandinavica, Vol. 68, No. 1, 2024, p. 35-42.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Prolonged effects of dexamethasone following total knee arthroplasty
T2 - A pre-planned sub-study of the DEX-2-TKA trial
AU - Derby, Cecilie Bauer
AU - Gasbjerg, Kasper Smidt
AU - Hägi-Pedersen, Daniel
AU - Lunn, Troels Haxholdt
AU - Pedersen, Niels Anker
AU - Lindholm, Peter
AU - Brorson, Stig
AU - Schrøder, Henrik Morville
AU - Thybo, Kasper Højgaard
AU - Bagger, Jens
AU - Lindberg-Larsen, Martin
AU - Overgaard, Søren
AU - Jakobsen, Janus Christian
AU - Mathiesen, Ole
N1 - © 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
PY - 2024
Y1 - 2024
N2 - OBJECTIVES: The DEX-2-TKA trial demonstrated that one and two doses of 24 mg intravenous dexamethasone reduced opioid consumption and pain after total knee arthroplasty (TKA). We aimed to investigate the prolonged effects of dexamethasone after the 48-h intervention period.DESIGN: This was a prospective, pre-planned questionnaire follow-up on postoperative days 3-7 of patients in the DEX-2-TKA trial that randomly received: DX1 (dexamethasone 24 mg + placebo), DX2 (dexamethasone 24 mg + dexamethasone 24 mg), and placebo (placebo + placebo) perioperatively and 24 h later.SETTING: A multicenter trial performed at five Danish hospitals.PARTICIPANTS: We analyzed 434 of 485 adult participants enrolled in the DEX-2-TKA trial.OUTCOME MEASURES: Primary outcome was difference between groups in average of all numerical rating scale (NRS) pain scores reported in the morning, at bedtime, and the daily average pain on postoperative days 3-7. Secondary outcomes were sleep quality and patient satisfaction.RESULTS: The median (interquartile range) pain intensity levels for postoperative days 3-7 were: DX2 3.2 (2.1-4.3); DX1 3.3 (2.3-4.1); and placebo 3.3 (2.5-4.7). Hodges-Lehmann median differences between groups were: 0 (95% confidence interval - 0.54 to 0.2), P = 0.38 between DX1 and placebo; 0.1 (-0.47 to 0.33), p = .87 between DX1 and DX2; and 0.1 (-0.6 to 0.13), p = .20 between DX2 and placebo. We found no relevant differences between groups on sleep quality on postoperative days 3-7 nor for patient satisfaction with the analgesic treatment.CONCLUSIONS: We found that neither one nor two doses of 24 mg intravenous dexamethasone demonstrated prolonged effects on overall pain or sleep quality on postoperative days 3-7 after total knee arthroplasty. We also found that dexamethasone had no effect on patient satisfaction.TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT03506789 (main result trial).
AB - OBJECTIVES: The DEX-2-TKA trial demonstrated that one and two doses of 24 mg intravenous dexamethasone reduced opioid consumption and pain after total knee arthroplasty (TKA). We aimed to investigate the prolonged effects of dexamethasone after the 48-h intervention period.DESIGN: This was a prospective, pre-planned questionnaire follow-up on postoperative days 3-7 of patients in the DEX-2-TKA trial that randomly received: DX1 (dexamethasone 24 mg + placebo), DX2 (dexamethasone 24 mg + dexamethasone 24 mg), and placebo (placebo + placebo) perioperatively and 24 h later.SETTING: A multicenter trial performed at five Danish hospitals.PARTICIPANTS: We analyzed 434 of 485 adult participants enrolled in the DEX-2-TKA trial.OUTCOME MEASURES: Primary outcome was difference between groups in average of all numerical rating scale (NRS) pain scores reported in the morning, at bedtime, and the daily average pain on postoperative days 3-7. Secondary outcomes were sleep quality and patient satisfaction.RESULTS: The median (interquartile range) pain intensity levels for postoperative days 3-7 were: DX2 3.2 (2.1-4.3); DX1 3.3 (2.3-4.1); and placebo 3.3 (2.5-4.7). Hodges-Lehmann median differences between groups were: 0 (95% confidence interval - 0.54 to 0.2), P = 0.38 between DX1 and placebo; 0.1 (-0.47 to 0.33), p = .87 between DX1 and DX2; and 0.1 (-0.6 to 0.13), p = .20 between DX2 and placebo. We found no relevant differences between groups on sleep quality on postoperative days 3-7 nor for patient satisfaction with the analgesic treatment.CONCLUSIONS: We found that neither one nor two doses of 24 mg intravenous dexamethasone demonstrated prolonged effects on overall pain or sleep quality on postoperative days 3-7 after total knee arthroplasty. We also found that dexamethasone had no effect on patient satisfaction.TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT03506789 (main result trial).
KW - Adult
KW - Humans
KW - Arthroplasty, Replacement, Knee
KW - Prospective Studies
KW - Pain, Postoperative/drug therapy
KW - Analgesics, Opioid
KW - Dexamethasone/therapeutic use
KW - Double-Blind Method
U2 - 10.1111/aas.14319
DO - 10.1111/aas.14319
M3 - Journal article
C2 - 37709280
VL - 68
SP - 35
EP - 42
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
SN - 0001-5172
IS - 1
ER -
ID: 378984683