In comparison with placebo, two doses of dexamethasone given perioperatively as an analgesic adjuvant to multimodal pain management with local infiltration analgesia, paracetamol, and ibuprofen mitigated pain and decreased morphine intake after total knee arthroplasty, as elucidated from a study published in The British Medical Journal.

Researchers undertook this randomized, placebo-controlled, blinded clinical trial [DEX-2-TKA] to explore the effects of one and two doses of dexamethasone in 485 people scheduled to undergo arthroplasty with follow-up at 90 days. With the aid of a computer-generated randomized sequence stratified for site, 485 volunteers were divided into following groups: (i) DX1 (24 mg dexamethasone + placebo, n=161); (ii) DX2 (24 mg dexamethasone + 24 mg dexamethasone, n=162); or (iii) placebo (placebo+placebo, n=162).

The intervention was administered preoperatively and after twenty-four hours. All the participants were given ibuprofen, paracetamol, and local infiltration analgesia. Total intravenous morphine consumption 0 to 48 hours postoperatively was the major endpoint ascertained while the intensity of postoperative pain (estimated using visual analogue scale [VAS]) was the secondary endpoint ascertained.

In the primary outcome assessment, data from 472 people (97.3%) were incorporated. Table 1 shows median (interquartile range) morphine intake at 0-48 hours.

Notably, the Hodges-Lehmann median differences between the groups were as follows: (i) 10.7 mg between DX2 and placebo, (ii) -2.7 mg between DX1 and DX2, and (iii) 7.8 mg between DX1 and placebo. The postsurgery pain decreased at twenty-four hours with 1 dose, and at forty-eight hours with 2 doses of intravenous dexamethasone.