These authors conducted a randomized controlled trial to study the effect of 10mg of dexamethasone administered within 90 minutes of arthroplasty. The primary outcome assessed was the average morphine equivalent use over the first 24 hours post-surgery. Secondary outcomes included postoperative visual analog scale (VAS) scores, anti-emetic use, postoperative nausea and vomiting and complications.
32 patients were randomized to the control group and 43 were randomized to the dexamethasone group.
Preoperatively, patients in both groups received one-time oral doses of acetaminophen 975 mg and pregabalin 100 mg. No brachial plexus blocks were used in this study.
Patients in the dexamethasone group received an intravenous dose of 10 mg dexamethasone within 90 minutes of surgery.
Both groups received an intraoperative 62-mL local infiltration cocktail injected into multiple locations composed of the following medications: 300 mg (60 mL) 0.5% ropivacaine, 30 mg (1 mL) ketorolac and 10 mg (1 mL) epinephrine.
During the first 24 hours postoperatively, all patients received the following multimodal pain medication: acetaminophen 975 mg orally every 8 hours, oxycodone 5 mg orally as needed every 4 hours for moderate pain or 10 mg for severe pain, 7.5 mg meloxicam orally every 6 hours, gabapentin 100 mg orally every 12 hours and diazepam 5 mg orally as needed for muscle spasms.
Average ondansetron use was significantly lower in the dexamethasone group compared to controls for the 0-4 hour interval and was lower overall for the first 24 hours.
Differences in VAS scores were significantly lower in the dexamethasone group at all time points. The average VAS score over the 24-hour period for the dexamethasone group was also significantly lower than the controls
Morphine equivalent use was significantly lower in the dexamethasone group compared to controls at 12- 16 hours and at 16-20 hours. When averaged over the first 24 hours, morphine equivalents were also significantly lower in the dexamethasone group.
There was no significant difference in glucose control or complications between groups.
They concluded that Dexamethasone decreases opioid requirements in the first 24 hours following surgery, provides improved pain control, and decreases antiemetic use following shoulder arthroplasty.
Comment: The Dexamethasone protocol used in this study appears to be safe and effective.
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