DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 136
Effect of Preoperative Methylprednisolone on Pain
and Recovery after Total Knee Arthroplasty: A Randomized,
Double-blind, Placebo-controlled Trial
Troels H. Lunn, Henrik Husted, Kristian Stahl Otte, Billy B Kristensen,
Lasse Ø Andersen, Lasse Ø Andersen, Henrik Kehlet
Dep. of anaesthesiology & Dep. of Orthopedics, Hvidovre University
Hospital, Dep. of surgical pathophysiology, Rigshospitalet
Background: Several postoperative clinical symptoms including pain are related
to the inflammatory stress response caused by the surgical trauma. Glucocorticoids
may provide positive analgesic effects by suppressing the inflammatory
response as demonstrated in many procedures. Unfortunately, no data exists in
total knee arthroplasty (TKA), where inflammation and pain is dominant.
Purpose: We hypothesized that a single, high- dose of methylprednisolone (MP)
would improve acute, postoperative analgesia after TKA.
Methods: Patients scheduled for unilateral, primary TKA were consecutively
included in a randomized, double-blind, placebo- controlled trial receiving preoperative
MP 125 mg IV or placebo (saline). The primary endpoint was pain
after walking 5 meters, and secondary endpoints were pain at rest, pain upon 45°
flexion of the hip with the leg straight, and pain upon 45 ° knee flexion. Assessment
was performed preoperatively and 2, 4, 6, 24, 28, 32 and 48h after surgery,
and in a questionnaire from day 2 to 10, and at follow up on day 21 and day 30.
Tertiary endpoints were postoperative nausea and vomiting (PONV), C-reactive
protein (CRP), sleep quality, fatigue, rescue analgesic- and antiemetic requirements,
length of stay (LOS) and side effects.
Findings: Forty-eight included patients (24 in each group) all completed the trial.
Pain scores were significantly lower in the MP group up to 32h postoperatively.
Summarized pain scores (2-48h) were lower for all assessments: pain after
walking (p=0.0002); pain at rest (p=0.002); pain upon flexion of the hip
(p=0.016); and pain upon knee flexion (p=0.001). Fewer patients required rescue
sufentanil in the PACU (p=0.017) and oxycodone requirement was lower from 0-
24h (p=0.012). PONV-frequency and consumption of antiemetic was reduced
(p