Does Dexamethasone reduce hospital readiness for discharge, pain, nausea and early patient satisfaction in hip and knee arthroplasty?: a randomized controlled trial

Background: Reduction of post-operative pain, nausea and vomiting in patients undergoing total joint arthroplasty may facilitate earlier discharge from hospital and reduce healthcare costs. This study was performed to primarily assess whether perioperative dexamethasone reduced hospital length of stay and to assess the effect on pain, nausea and vomiting and patient satisfaction.

Methods: 164 patients undergoing THA or TKA were randomized to receive either 8mg IV dexamethasone (n=86) or placebo (n=78) at induction and at 24 hours post surgery. The primary outcome was length of stay and secondary outcomes were pain and nausea VAS scores, analgesic and anti-emetic usage, blood glucose level (BGL) and patient satisfaction.

Results: Participants in the study group achieved earlier readiness for discharge. There was a 20% reduction in pain scores and morphine usage was 27% lower in the study group. Nausea scores were similar in the two groups but there was lower anti-emetic usage in the study group. Satisfaction scores at six weeks post-surgery in the dexamethasone group were significantly higher than the placebo group. There was no difference in complication rates between the two groups.

Conclusion: The administration of IV dexamethasone could lead to earlier readiness for discharge especially in patients undergoing elective THA, primarily by a reduction in post-operative pain scores and/or morphine requirements.