Table 4.
Summary of randomized controlled trials of corticosteroid use after TKA
| Study | Patients and study design | Equivalency to dexamethasone | Anesthesia and pain control protocol | Clinical benefits and safety |
|---|---|---|---|---|
| Fujii et al. [15] |
80 unilateral TKAs 3 groups of 20 dexamethasone (4 mg, 8 mg, 16 mg) versus 20 placebo |
4, 8, 16 mg | General anesthesia Continuous epidural infusion |
Study period: 0–24 hours; PONV incidence: lower in 8 mg & 16 mg dexamethasone (control vs 8 mg vs 16 mg = 65% vs 30% vs 25%); no wound complication |
| Lunn et al. [38] |
48 unilateral TKAs 24 methyprednisolone (125 mg) versus 24 placebo |
25 mg | Preemptive gabapentin, acetaminophen, celecoxib; spinal anesthesia; periarticular injection; rescue sulfentanyl and oral oxycodone; regular celecoxib, acetaminophen, gabapentin |
Study period: 0–4, 4–6, 6–24, & 24–48 hours; PONV Incidence: lower with methylprednisolone 24–48 hours (0% vs 21%); nausea severity: lower with methylprednisolone 0–24 hours; rescue: lower with methylprednisolone 0–48 hours; pain: lower with methylprednisolone 2–48 hours; opioid use: lower with methylprednisolone 0–24 hours; no wound complications |
| Jules-Elysee et al. [23] | 34 simultaneous bilateral TKAs 17 hydrocortisone (300 mg) versus 17 placebo |
11.3 mg | Combined spinal-epidural anesthesia; Continuous femoral nerve block; epidural PCA; rescue Percocet (oxycodone + acetaminophen) |
Study period: 0–12, 12–24 hours; PONV incidence: no difference (18% vs 18%); pain: lower with hydrocortisone 0–24 hours; opioid use: lower with hydrocortisone 0–24 hours; no wound complications |
| Current study | 269 unilateral TKAs 135 dexamethasone (10 mg) with ramosetron (0.3 mg) versus 134 ramosetron (0.3 mg) |
10 mg | Preemptive oxycodone, celecoxib, gabapentin, acetaminophen; spinal anesthesia; continuous femoral nerve block; periarticular injection; intravenous PCA; regular celecoxib, gabapentin, acetaminophen |
Study period: 0–6, 6–24, 24–48, 48–72 hours; PONV incidence: lower in dexamethasone 0–6 hours & overall 72 hours (22% vs 37% & 24% vs 40%, respectively); nausea severity: lower with dexamethasone 0–6 hours; rescue: lower with dexamethasone 0–6 hours & overall 72 hours; pain: lower with dexamethasone 6–24 hours; opioid use: lower with dexamethasone 6–24 hours & overall 72 hours; no differences in wound complications |
PONV = postoperative nausea and vomiting; vs = versus; PCA = patient-controlled analgesia; Percocet (Endo Pharmaceuticals, Malvern, PA, US).