Abstract
PurposeThe aim of the study was to assess whether administration of a single dose of methylprednisolone in the group patients above 65 years of age will be effective in complex analgesic management after total hip arthroplasty (THA).MethodsSeventy-seven patients above 65 years old were double-blind randomized into two: the study and controls groups. Pre-operatively, the study group received as a single dose of 125 mg intravenous methylprednisolone, while the others saline solution as placebo. Peri-operatively, all the patients were administered opioid and nonopioid analgesic agents. We measured the levels of inflammatory markers (leukocytosis, C-reactive protein—CRP), pain intensity level (visual analog scale—VAS; numerical rating scale—NRS), the life parameters, and noted complications.ResultsFollowing administration of methylprednisolone were significantly lower levels of CRP on all the four post-operative days; leukocytosis on the second day; the VAS/NRS score at rest after six, 12, and 18 hours post-operatively, diminished the dose of parenteral opioid preparations (oxycodone hydrochloride), the duration of analgesia by peripheral nerve block was significantly higher as compared with the placebo group (p < 0.000001). No infectious complications were noted; there was one patient who developed post-operative delirium.ConclusionA single dose of methylprednisolone significantly reduces the level of post-operative pain at rest on the day of THA in the group patients above 65 years of age, decreases the dose of opioid analgesic agents, and significantly decreases the level of inflammatory markers, without infectious processes.
Highlights
Total hip and knee arthroplasties are associated with considerable pain between the sixth and 24th post-operative hour [1,2,3]
Of interest is whether Enhanced Recovery After Surgery (ERAS) protocol is effective in the group patients older than 65 years, who more commonly suffer from concomitants diseases and whose comorbidities are more advanced; the physiological functional reserve is decidedly lower due to systemic involution [10,11,12,13, 15]
The management aiming at reducing the inflammatory process and pain for chronic osteoarthritis is commonly administered intra-articular glucocorticoid injections, the interest, whether administration only once, as a “pre-emptive” analgesia, may effectively limit acute pain, will not the immunosuppressive effect resulting among others from blocking the elements of the native immune system, increase the risk of infectious complications
Summary
Total hip and knee arthroplasties are associated with considerable pain between the sixth and 24th post-operative hour [1,2,3]. The management aiming at reducing the inflammatory process and pain for chronic osteoarthritis is commonly administered intra-articular glucocorticoid injections, the interest, whether administration only once, as a “pre-emptive” analgesia, may effectively limit acute pain, will not the immunosuppressive effect resulting among others from blocking the elements of the native immune system, increase the risk of infectious complications. Numerous reports have indicated an effective use of methylprednisolone as an element of multimodal analgesia in orthopaedic surgery [1, 9, 16,17,18,19,20,21] International Orthopaedics (SICOT) (2021) 45:857–863 developing? Numerous reports have indicated an effective use of methylprednisolone as an element of multimodal analgesia in orthopaedic surgery [1, 9, 16,17,18,19,20,21]
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