Preemptive low-dose dexamethasone reduces postoperative emesis and pain after TKA: a randomized controlled study

Area of Science:

• Anesthesiology
• Orthopedic Surgery
• Pharmacology

Background:

• Dexamethasone is a known analgesic and antiemetic.
• Its specific benefits in total knee arthroplasty (TKA) within multimodal regimens require clarification.

Purpose of the Study:

• To evaluate if dexamethasone plus ramosetron reduces postoperative emesis compared to ramosetron alone after TKA.
• To assess the impact on postoperative pain and wound complication risks within a multimodal approach.

Main Methods:

• A randomized trial involving 269 patients undergoing TKA.
• Patients received either dexamethasone with ramosetron (Dexa-Ra) or ramosetron alone (Ra).
• Outcomes measured included postoperative nausea and vomiting (PONV), pain, opioid consumption, and wound complications up to one year post-surgery.

Main Results:

• The Dexa-Ra group showed a lower incidence of PONV and less severe nausea in the initial 6 hours.
• Significantly reduced pain and opioid consumption were observed in the Dexa-Ra group during the 6-24 hour period and overall.
• No significant differences in wound complications or periprosthetic joint infections were noted between the groups.

Conclusions:

• Prophylactic dexamethasone combined with ramosetron effectively reduces postoperative emesis and pain after TKA.
• This combination is safe, showing no increased risk of wound complications when used in a multimodal regimen.