Effects of Perioperative Intravenous Dexamethasone on the Severity of Persistent Postsurgical Pain After Total Knee Arthroplasty : A Prospective, Randomized, Double-blind, Placebo-controlled Trial

Effects of Perioperative Intravenous Dexamethasone on the Severity of Persistent Postsurgical Pain After Total Knee Arthroplasty : A Prospective, Randomized, Double-blind, Placebo-controlled Trial

To compare the effects of perioperative intravenous Dexamethasone with a placebo on the severity of persistent postsurgical pain after total knee arthroplasty.

It is not clear whether perioperative intravenous Dexamethasone has an effect on severity of persistent postsurgical pain (PPSP) after total knee arthroplasty (TKA). The research hypothesis is that TKA patients experience less severe PPSP after administration of perioperative intravenous Dexamethasone.

Inclusion Criteria:

• Age > 40 years (45)
• Primary knee osteoarthritis diagnosed using the American College of Rheumatology criteria (46)
• Undergoing elective, primary and unilateral total knee arthroplasty
• American Society of Anesthesiology (ASA) physical status class 1-3
• BMI < 40 kg/m2

Exclusion Criteria:

• History of active rheumatic diseases
• History of previous musculoskeletal injury of the same knee for excluding patients with secondary knee osteoarthritis
• History of previous surgery on the same knee
• History of adverse effects from medications to be used in this study
• Contraindication to spinal anesthesia
• History of psychiatric disorders or cognitive impairment
• Contraindication to corticosteroid agents
• Poorly controlled diabetes mellitus (HbA1C > 7.5)
• Poorly controlled hypertension
• History of ischemic heart disease or peripheral arterial disease or cerebrovascular disease
• Hepatic insufficiency (Child-Pugh score > 5)
• Renal insufficiency (Creatinine clearance < 30 mL/min)
• History of cataracts or glaucoma or ocular hypertension
• History of steroid or immunosuppressive drug use within 6 months of surgery