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Steroids Significantly Decrease Postoperative Postural Hypotension in Total Knee Replacement.

Gloria H M Cheng1, Gabriel K Y Tan2, Muhammad F B Kamarudin1

  • 1Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.

The Journal of Knee Surgery
|July 8, 2021
PubMed
Summary
This summary is machine-generated.

Postoperative dexamethasone use significantly reduces the risk of early postural hypotension (PH) after total knee replacement (TKR). This finding supports dexamethasone as a key intervention in enhanced recovery after surgery (ERAS) protocols for TKR patients.

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Area of Science:

  • Orthopaedic Surgery
  • Anesthesiology
  • Pharmacology

Background:

  • Enhanced recovery after surgery (ERAS) protocols aim to optimize patient outcomes following total knee replacement (TKR).
  • Multimodal prophylaxis, including antiemetics like dexamethasone, is used to manage postoperative nausea and vomiting (PONV) and potentially other complications.
  • Dexamethasone's anti-inflammatory properties may influence autonomic regulation, potentially impacting conditions like postural hypotension (PH).

Approach:

  • This retrospective study analyzed data from 149 patients undergoing elective primary TKR between September 2017 and March 2020.
  • Patients were stratified based on the administration of postoperative dexamethasone.
  • Binary logistic regression was employed to assess the association between dexamethasone use and the incidence of early postoperative PH, controlling for confounders.

Key Points:

  • Patients receiving postoperative dexamethasone showed a statistically significant reduction in the incidence of early postoperative postural hypotension (OR = 0.31, p = 0.03).
  • Dexamethasone use was also associated with significantly lower rates of postoperative nausea and vomiting (OR = 0.21, p = 0.006).
  • While a trend towards improved early physiotherapy participation was observed, this did not reach statistical significance (OR = 2.42, p = 0.14).

Conclusions:

  • Postoperative intravenous dexamethasone administration is significantly associated with decreased rates of early postural hypotension following total knee replacement.
  • Dexamethasone appears to be a valuable component of ERAS protocols for TKR, contributing to better patient recovery.
  • Further research is warranted to determine optimal dexamethasone dosing and frequency and to explore its full potential in enhancing early postoperative mobilization.