Preoperative high-dose Steroids in Total Knee and Hip Arthroplasty – Protocols for three randomized controlled trials
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Preoperative high-dose Steroids in Total Knee and Hip Arthroplasty – Protocols for three randomized controlled trials. / Nielsen, Niklas I.; Kehlet, Henrik; Gromov, Kirill; Troelsen, Anders; Husted, Henrik; Varnum, Claus; Kjærsgaard-Andersen, Per; Rasmussen, Lasse E.; Mandøe, Hans; Foss, Nicolai B.
In: Acta Anaesthesiologica Scandinavica, Vol. 64, No. 9, 2020, p. 1350-1356.Research output: Contribution to journal › Journal article › Research › peer-review
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T1 - Preoperative high-dose Steroids in Total Knee and Hip Arthroplasty – Protocols for three randomized controlled trials
AU - Nielsen, Niklas I.
AU - Kehlet, Henrik
AU - Gromov, Kirill
AU - Troelsen, Anders
AU - Husted, Henrik
AU - Varnum, Claus
AU - Kjærsgaard-Andersen, Per
AU - Rasmussen, Lasse E.
AU - Mandøe, Hans
AU - Foss, Nicolai B.
PY - 2020
Y1 - 2020
N2 - Background: Patients undergoing total knee arthroplasty (TKA)/ total hip arthroplasty (THA) still experience moderate-severe postoperative pain despite optimized pain management regimes. The patients already on opioid treatment and pain catastrophizers (PCs) have a higher risk of postoperative pain. The use of preoperative intravenous high-dose glucocorticoids decreases postoperative pain after TKA and THA, but optimal dose is yet to be found, and the effect on subpopulations at high pain risk is unknown. Aim: To investigate the effect of a higher than previously used dose of glucocorticoids (dexamethasone (DXM)), administered intravenously before surgery, as part of standardized fast-track regimen, on postoperative pain in TKA/THA subgroups. Method: Three separate randomized, double-blinded, controlled trials were planned to compare a new higher dose DXM (1 mg/kg) to the earlier used high-dose DXM (0.3 mg/kg). Study 1: predicted Low Pain TKA; study 2: predicted High Pain Responder (HPR) TKA; study 3: predicted HPR THA. Predicted HPR groups consist of either PCs with PCS-score of ≥ 21 and/or history of ongoing opioid-treatment of 30 mg/day of morphine or equivalents > 30 days. In total, 408 patients were planned for inclusion (160 Low Pain TKA, 88 HPR TKA, 160 HPR THA). Primary outcome : Pain upon ambulation in a 5-meter walk test 24 hours after surgery. Secondary outcomes include use of analgesics, rescue-opioids, antiemetics, cumulated pain, CRP, OR-SDS, QoR-15, quality of sleep, length of stay (LOS), reasons for hospitalization, readmission, morbidity, and mortality. Patients completed follow-up on day 90. Recruiting commenced February 2019 and is expected to finish in September 2020.
AB - Background: Patients undergoing total knee arthroplasty (TKA)/ total hip arthroplasty (THA) still experience moderate-severe postoperative pain despite optimized pain management regimes. The patients already on opioid treatment and pain catastrophizers (PCs) have a higher risk of postoperative pain. The use of preoperative intravenous high-dose glucocorticoids decreases postoperative pain after TKA and THA, but optimal dose is yet to be found, and the effect on subpopulations at high pain risk is unknown. Aim: To investigate the effect of a higher than previously used dose of glucocorticoids (dexamethasone (DXM)), administered intravenously before surgery, as part of standardized fast-track regimen, on postoperative pain in TKA/THA subgroups. Method: Three separate randomized, double-blinded, controlled trials were planned to compare a new higher dose DXM (1 mg/kg) to the earlier used high-dose DXM (0.3 mg/kg). Study 1: predicted Low Pain TKA; study 2: predicted High Pain Responder (HPR) TKA; study 3: predicted HPR THA. Predicted HPR groups consist of either PCs with PCS-score of ≥ 21 and/or history of ongoing opioid-treatment of 30 mg/day of morphine or equivalents > 30 days. In total, 408 patients were planned for inclusion (160 Low Pain TKA, 88 HPR TKA, 160 HPR THA). Primary outcome : Pain upon ambulation in a 5-meter walk test 24 hours after surgery. Secondary outcomes include use of analgesics, rescue-opioids, antiemetics, cumulated pain, CRP, OR-SDS, QoR-15, quality of sleep, length of stay (LOS), reasons for hospitalization, readmission, morbidity, and mortality. Patients completed follow-up on day 90. Recruiting commenced February 2019 and is expected to finish in September 2020.
U2 - 10.1111/aas.13656
DO - 10.1111/aas.13656
M3 - Journal article
C2 - 32533723
AN - SCOPUS:85087161358
VL - 64
SP - 1350
EP - 1356
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
SN - 0001-5172
IS - 9
ER -
ID: 258663282