Early postoperative recovery after peri-acetabular osteotomy: A double-blind, randomised single-centre trial of 48 vs. 8 mg dexamethasone

研究概要

Sixty-four patients undergoing a peri-acetabular osteotomy were randomized to receive a standard 8mg pre-operative dose of intravenous dexamethasone (n=32) or 48mg of pre-operative dexamethasone (n=32). The primary outcome of interest was incidence of moderate to severe pain (a score >3 on a 10 point Numeric Rating Scale [NRS]) in the PACU. Secondary outcomes included the following: average and maximum pain in the immediate postoperative phase, incidence of complications requiring treatment in the PACU (i.e., nausea and circulatory or respiratory events), incidence of sedation in the PACU, length of stay in the PACU, length of hospital stay, opioid usage in oral morphine equivalents (OMEQs), usage of antiemetic treatment up to 4 days follow-up, incidence of complications requiring treatment during the 1st day, incidence of adverse events at 60-hours follow-up, incidence of any complications, and incidence of readmissions up to 30 days. Tertiary outcomes included the following self-reported measures: average and worst pain using a NRS, incidence of average and worst nausea and vomiting, quality of sleep (i.e., good, difficulty falling asleep, frequent awakenings, or no sleep), and the incidence of feeling sad, restless or fatigued, which were all measured at day 0 to 4 days post-surgery. Results demonstrated that moderate to severe pain using NRS was similar between the 8mg group and 48mg group, with no statistically significant difference observed (66% vs. 75%; p=0.585). Furthermore, no statistically significant difference was observed for any of the secondary outcomes except for cumulative opioid usage in OMEQs, in which a statistical significant difference was observed favoring the 48mg dexamethasone group compared to standard dose (p=0.034) at 4 days post-surgery. Opioid usage was statistically significantly reduced at day 1 post-surgery in the 48mg group vs standard dose group (p=0.044). All tertiary outcomes were also not statistically significantly different between the 2 dosage groups except for quality of sleep, whereby statistically significantly more patients reported restlessness in the 48mg group vs 8mg group (p=0.042). No complications in the 1st 30 days post-surgery were observed. 1 patient reported a serious adverse event in the standard dose group.