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Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial.

Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial

  1. T. H. Lunn1,2,*,
  2. L. Ø. Andersen1,2,
  3. B. B. Kristensen1,2,
  4. H. Husted2,3,
  5. L. Gaarn-Larsen2,
  6. T. Bandholm3,4,5,
  7. S. Ladelund4 and
  8. H. Kehlet2,6

+Author Affiliations


  1. 1Department of Anaesthesiology,

  2. 2The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty,

  3. 3Department of Orthopaedic Surgery,

  4. 4Clinical Research Centre, and

  5. 5Department of Physical Therapy, Hvidovre University Hospital, Kettegård Allé 30, DK-2650 Copenhagen, Denmark

  6. 6Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  1. *Corresponding author. E-mail: lunn@dadlnet.dk
  • Accepted June 21, 2012.

Abstract

Background

High-dose glucocorticoid may reduce postsurgical pain and improve recovery. We hypothesized that 125 mg methylprednisolone (MP) would reduce time to meet functional discharge criteria after total hip arthroplasty (THA).

Methods Forty-eight patients undergoing unilateral THA under spinal anaesthesia were consecutively included in this randomized, double-blind, placebo-controlled trial receiving preoperative i.v. MP or saline. All patients received a standardized, multimodal analgesic regime with paracetamol, celecoxib, and gabapentin. The primary outcome was time to meet well-defined functional discharge criteria. Secondary outcomes were handgrip strength and endurance, pain, nausea, vomiting, fatigue, sleep quality, and rescue analgesic-, antiemetic-, and hypnotic medicine requirements. The inflammatory response measured by C-reactive protein (CRP) and actual length of stay were also registered. Discharge criteria were assessed twice daily (at 09:00 and 14:00 h) until discharge. Other outcomes were assessed at 2, 4, 6, 8, and 24 h after operation, and also in a questionnaire from postoperative day (POD) 1–4.

Results

Time to meet discharge criteria was [median (IQR) (95% CI), MP vsplacebo]: 23.5 (23.3–23.7) (17.8–43.8) vs 23.5 (23.0–23.8) (20.0–46.8) h, the mean difference (95% CI) being −1.3 (−4.7 to 2.2) h, P=0.65. Overall pain for the first 24 h after surgery was significantly reduced in the MP vsthe placebo group (P<0.01), as was CRP at 24 h (P<0.0001). No other between-group differences were observed. No drug-related complications were observed at follow-up on POD30.

Conclusions

MP 125 mg i.v. before surgery added to a multimodal oral analgesic regime did not reduce time to meet functional discharge criteria after THA, but improved analgesia for the first 24 h.

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