2024 EFORT Annual Meeting: A randomised, double-blind, placebo-controlled trial on the efficacy of dexamethasone combined with neuraxial anesthesia in reducing pain and opioid consumption after primary cementless total hip arthroplasty using the direct anterior approach

Ninety patients undergoing total hip arthroplasty via direct anterior approach with neuraxial anesthesia were randomized to receive either a single dose of 10 mg dexamethasone IV (n=45) or a placebo (isotonic saline IV) (n=45) intra-operatively. The primary outcome of interest was pain level measured through a visual analog score (VAS) at 1, 3, 6, 12, and 24 hours post-operatively; opioid use measured as the sum of morphine equivalents (MME); and range of motion (ROM) 24 hours post-operatively. Secondary outcomes included the time-up-and-go (TUG) test and in-hospital complications. Outcomes were assessed up to 24 hours post-operatively. Overall, the results of the study revealed that the dexamethasone group reported significantly lower opioid use (P<0.01) and VAS scores at 6 and 12 hours post-operative (P=0.02 and P=0.01, respectively). There were no significant differences in ROM, TUG test results, or complications between the groups. The findings suggest that intra-operative dexamethasone effectively reduces postoperative pain and opioid use without adverse effects.