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Early postoperative recovery after peri-acetabular osteotomy: A double-blind, randomised single-centre trial of 48
Kristin J Steinthorsdottir1, Hussein N Awada, Jesper Dirks
1From the Department of Anaesthesiology, Centre for Cancer and Organ Diseases (KJS, HNA, EKA), the Surgical Pathophysiology Unit (KJS, HK), the Department of Anaesthesiology, Centre of Head and Orthopaedics (JD), the Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (JS, NSW).
Background:
Peri-acetabular osteotomy is the joint-preserving treatment of choice in young adults with hip dysplasia but is associated with intense pain and high opioid consumption postoperatively.
Objectives:
To investigate whether 48 mg of pre-operative dexamethasone was superior to a standard dose of 8 mg on reducing pain in the immediate postoperative phase.
Design:
A randomised, double-blind trial.
Setting:
Single-centre, primary facility. May 2017 to August 2019.
Patients:
At least 18 years undergoing peri-acetabular osteotomy.
Interventions:
Patients were randomised 1 : 1 to 48 or 8 mg dexamethasone intravenous (i.v.) as a single pre-operative injection. All patients received a standardised peri-operative protocol, including pre-operative acetaminophen and gabapentin, total i.v. anaesthesia and local anaesthetic catheter based wound administration.
Main Outcome Measure:
Number of patients with moderate/severe pain [>3 on a numeric rating scale (NRS)] in the immediate postoperative phase.
Results:
Sixty-four patients (32 in each group) were included, and their data analysed. At some point from tracheal extubation until transfer to the ward, the NRS was more than 3 in 75% (24/32) of the 48 mg group and in 66% (21/32) in the 8 mg group, odds ratio 1.571 (95% CI, 0.552 to 4.64), P = 0.585. Patients in the 48 mg group received less opioid [cumulative rescue analgesics, oral morphine equivalents (OMEQ)] during postoperative days 0-4: median [IQR] OMEQ was 36 [15 to 85] mg vs. 79 [36 to 154] mg in the 48 and 8 mg group, respectively, P = 0.034. There were no statistically significant differences regarding complications, rate of infections or readmissions.
Conclusion:
Forty-eight milligram of dexamethasone did not reduce pain in the immediate postoperative phase compared with an 8 mg dose. We observed insignificantly lower pain scores and significantly lower cumulated opioid requirements in the 48 mg group during the first four postoperative days.
Trial Registration:
Clinicaltrials.gov, NCT03161938, EudraCT (2017-000544-1).
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