RESUMO
Controlling postoperative pain and nausea after total joint arthroplasty remains an important challenge. We conducted a prospective, randomized controlled trial with 120 patients to determine if the addition of perioperative dexamethasone to a multimodal regimen improves antiemetic and analgesic control, enhances mobility, and shortens hospital length of stay after total hip and knee arthroplasty. Patients administered 10mg of intravenous dexamethasone intraoperatively consumed less daily rescue anti-emetic and analgesic medication, reported superior VAS nausea and pain scores, ambulated further distances, and had a significantly shorter length of stay compared to the control group (P<0.05). A second, 24-hour postoperative dose of 10mg intravenous dexamethasone provided significant additional pain and nausea control and further reduced length of stay (P<0.05). No adverse events were detected with the administration of the intraoperative and/or postoperative dexamethasone.
Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Tempo de Internação/estatística & dados numéricos , Dor Pós-Operatória/prevenção & controle , Náusea e Vômito Pós-Operatórios/prevenção & controle , Administração Intravenosa , Idoso , Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Antieméticos/administração & dosagem , Antieméticos/uso terapêutico , Distinções e Prêmios , Dexametasona/administração & dosagem , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Glucocorticoides/administração & dosagem , Humanos , Incidência , Masculino , Dor Pós-Operatória/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Estudos Prospectivos , Estados UnidosRESUMO
Fever and leukocytosis are common after joint arthroplasty, often resulting in additional studies. This study was conducted to determine the incidence of fever and leukocytosis after joint arthroplasty and the use of tests. We retrospectively reviewed records (n = 426) of patients who underwent knee or hip arthroplasty between February 2006 and April 2008 to determine the incidence of fever and leukocytosis, tests, and results. Sixty-four had fever, and 247 had postoperative leukocytosis. Sixty additional tests were performed; 6 (10%) of 60 tests were clinically relevant. After joint arthroplasty, more than half of patients developed leukocytosis, and nearly 15% developed fever. Diagnostic testing should be based on physical examination or symptomatic findings and not solely on laboratory values or vital signs, decreasing the patient discomfort and potentially lower costs.
