Reducing Orthopedic Surgery Opioid Use Without Impacting Satisfaction

A randomized double-blinded placebo-controlled trial revealed that perioperative intravenous dexamethasone significantly reduces postoperative opioid requirement and nausea after unilateral elective hip arthroscopy. 

Previous studies have shown that dexamethasone has a positive effect on postoperative pain control, opioid consumption, nausea and vomiting, and length of hospital stay after arthroplasty surgery. The purpose of this randomized controlled and double-blinded study was to assess whether adding perioperative dexamethasone to our current pain regimen after hip arthroscopy is more effective than a placebo. It was hypothesized that dexamethasone would reduce postoperative pain, reduce opioid consumption, improve subjective pain and nausea scores, and reduce the number of vomiting events.

A total of 50 patients requiring unilateral elective hip arthroscopy were randomized to receive intravenous dexamethasone immediately before induction of anesthesia and at 8 a.m. on the first postoperative day (2 ×12 mg) or a placebo (sodium chloride 0.9 %). The patient, the surgeons, the treating anesthesiologist, and the nursing and physical therapy personnel involved were blinded to group assignment. The primary outcome was postoperative pain, and secondary outcomes were opioid consumption and nausea scores — assessed using a translated, revised version of the American Pain Society Patient Outcome Questionnaire 6 hours postoperatively and on days 1 and 2 — and vomiting events. A clinical follow-up was performed 12 weeks postoperatively to assess adverse events.

The two groups were comparable regarding their demographics. Postoperative pain levels did not differ significantly in most instances. Opioid requirements during the hospitalization in the dexamethasone group were signifi cantly lower than those in the placebo group (31.96 ± 20.56 mg vs 51.43 ± 38 mg; P = .014). Significantly fewer vomiting events were noted in the dexamethasone group (0.15 ± 0.59 vs 0.65 ± 0.91; P = .034).

Perioperative intravenous dexamethasone significantly reduced postoperative opioid consumption by 40 % without compromising pain level and safety, as no corticosteroid-related side effects were observed. Dexamethasone may be a valuable adjuvant to a multimodal systemic pain regimen after hip arthroscopy.