A study depicted that after total hip arthroplasty, a split-dose dexamethasone approach is better than a single elevated dose dexamethasone approach in minimizing pain.

A randomized, prospective, placebo-controlled, double-blind study was carried out to investigate the efficacy and safety of a single preoperative high dose regimen of intravenous dexamethasone versus the two equivalent perioperative split doses of dexamethasone in reducing pain and improving function following total hip arthroplasty.

The study enrolled 165 patients diagnosed with osteoarthritis of the hip and scheduled for primary elective total hip arthroplasty. Participants were randomized into three cohorts: (i) Group A (placebo) that received 2 perioperative saline injections (n=55), (ii) Group B that received a single preoperative dose of 20 mg dexamethasone and a postoperative saline injection (n=55) and, (iii) Group C that received 2 perioperative doses of 10 mg dexamethasone (n=55).

Postoperative pain level stated on a 10-point Numerical Rating Scale (NRS) at rest and during activity (from a sitting to standing position) was the study's primary endpoint. The following parameters were also compared: (i) postoperative nausea and vomiting (PONV) incidence, (ii) patient satisfaction, (iii) C-reactive protein (CRP) and interleukin-6 (IL-6) levels, (iv) range of motion, (v) length of stay, (vi) Usage of analgesic and antiemetic rescue, and (vii) the incidence of surgical site infection and gastrointestinal bleeding in the three months after surgery.

On postsurgery days 1 and 2, the pain scores at rest were remarkably diminished in Groups B and C in comparison with Group A. On postsurgery days 1, 2, and 3, a significant decrease in the dynamic pain scores and the levels of CRP and IL-6 for Groups B and C were witnessed in comparison with Group A, as depicted in the following figure:

Compared to Group A, subjects in Groups B and C were found to have a reduced PONV incidence, shorter length of stay, declined usage of analgesic and antiemetic rescue agents, improved range of motion, and better satisfaction. Compared to Group B, subjects in Group C had substantially declined IL-6 level, CRP levels, and dynamic pain scores on postsurgery days 2 and 3, and better range of motion and satisfaction on post-surgery day 3. No surgical site infection and gastrointestinal bleeding were witnessed in any group.

Thus, a split-dose dexamethasone regimen is superior compared to a single high dose regimen in minimizing pain, inflammation, PONV, and improving range of motion with better patient satisfaction.