Abstract
BackgroundIntraoperative periarticular injection of corticosteroid effectively reduces perioperative pain in total knee arthroplasty (TKA). However, which corticosteroid is most effective for intraoperative periarticular injection remains controversial. We compared the effects of corticosteroids between dexamethasone and triamcinolone acetonide periarticular administration for reducing pain and postoperative nausea and increasing fasting blood glucose concentrations during the perioperative period following TKA.MethodsOne hundred and two patients who underwent TKA from August 2018 to September 2020 were divided into two groups: one received 10 mg dexamethasone for intraoperative periarticular injection and another receiving 40 mg triamcinolone acetonide. Postoperative pain scores at rest and during walking and nausea scores were recorded using a 0-to-10 Numerical Rating Scale. C-reactive protein (CRP) and fasting blood glucose levels were measured pre- and postoperatively.ResultsPain scores in the triamcinolone group were significantly lower than in the dexamethasone group at rest 7 days postoperatively (1.5 vs. 2.0; p = 0.046) and while walking at both 72 h (3.9 vs. 4.8; p = 0.008) and 7 days postoperatively (3.2 vs. 4.0; p = 0.03). The CRP levels in the triamcinolone group were significantly lower than in the dexamethasone group at 7 days postoperatively (1.6 mg/dl vs. 3.0 mg/dl: p < 0.001). The fasting blood glucose levels at 1 day postoperatively were increased in both groups but not significantly different between the groups. No significant differences in the nausea score were noted between the groups.ConclusionsTriamcinolone acetonide periarticular administration provided greater pain relief by reducing inflammation to a greater degree than dexamethasone.
Highlights
Intraoperative periarticular injection of corticosteroid effectively reduces perioperative pain in total knee arthroplasty (TKA)
Referring to the concern of hyperglycemia caused by the administration of corticosteroids, a previous study showed that the fasting blood glucose levels of the patients treated with triamcinolone acetonide periarticular injections were significantly increased the morning after TKA [9]
Preoperative fasting blood glucose levels were significantly higher in the triamcinolone group than in the dexamethasone group, but other demographic characteristics and preoperative laboratory data showed no significant differences between the groups (Table 1)
Summary
Intraoperative periarticular injection of corticosteroid effectively reduces perioperative pain in total knee arthroplasty (TKA). We compared the effects of corticosteroids between dexamethasone and triamcinolone acetonide periarticular administration for reducing pain and postoperative nausea and increasing fasting blood glucose concentrations during the perioperative period following TKA. Intraoperative administration of corticosteroid during total knee arthroplasty (TKA) has been reported to reduce perioperative pain and prevent nausea [1,2,3,4,5,6,7,8], and the routes of administration include intravenous and periarticular administration. Referring to the concern of hyperglycemia caused by the administration of corticosteroids, a previous study showed that the fasting blood glucose levels of the patients treated with triamcinolone acetonide periarticular injections were significantly increased the morning after TKA [9].
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