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The Archives of Bone and Joint Surgery، جلد ۱۱، شماره ۳، صفحات ۰-۰
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عنوان انگلیسی Repeat High-Dose Dexamethasone May Improve Recovery 48 Hours after Total Hip Arthroplasty
چکیده انگلیسی مقاله Objectives: Perioperative dexamethasone is an effective anti-emetic and systemic analgesic in total hip arthroplasty (THA) that may reduce opioid consumption and enhance rapid recovery. However, there is no consensus on the optimal perioperative dosing that is safe and effective for faster rehabilitation and improved pain control while maintaining safe blood glucose levels. Methods: A retrospective review of 101 primary THA patients at a single institution who received perioperative dexamethasone was conducted. Patients were stratified by dexamethasone induction dosage (10 mg as high, < 6mg as low) and whether a repeat dose was given 16-24 hours postoperatively. Age, gender, BMI, diabetes status, and ASA were controlled between groups. The pain was evaluated with inpatient morphine milligram equivalents (MME) requirements and visual analog scale (VAS) at 8, 16, and 24 hours postoperatively. Mobility was assessed by inpatient ambulation distance, Boston AM-PAC mobility score, and percentage of gait assistance as determined by a physical therapist. Secondary outcomes included postoperative nausea and vomiting (PONV) limiting therapy sessions, PONV requiring breakthrough anti-emetics, glucose levels, surgical site infection, wound healing complications, and discharge destination. Results: : Compared to patients receiving one dose of high or low dexamethasone, patients receiving two dosages of high-dose dexamethasone had significantly further ambulation distance and lower percentage of gait assistance on postoperative day 2. A generalized linear model also predicted that any repeat dexamethasone, regardless of dosage, significantly improved ambulation distance and gait assistance compared to the one-dose cohort. There was no statistically significant difference between VAS scores, MME requirements, PONV, postoperative glucose levels >200, discharge destination, or risk of infection between groups. Conclusion: A repeat high-dose dexamethasone, the morning after surgery, may improve percentage of gait assistance and ambulation endurance on postoperative day two. There was no risk of uncontrolled glucose levels or infections compared to receiving one dose of dexamethasone at induction. Level of evidence: III
کلیدواژه‌های انگلیسی مقاله Dexamethasone, peri-operative management, Pain Control, patient outcomes, Total hip arthroplasty
نویسندگان مقاله | Brandon Lung
University of California, Irvine Department of Orthopedic Surgery, Orange, CA, USA


| Ryan Le
University of California, Irvine Department of Orthopedic Surgery, Orange, CA, USA


| Maddison McLellan
University of California, Irvine Department of Orthopedic Surgery, Orange, CA, USA


| Kylie Callan
University of California, Irvine Department of Orthopedic Surgery, Orange, CA, USA


| Megan Donnelly
University of California, Irvine Department of Orthopedic Surgery, Orange, CA, USA


| Justin Yi
University of California, Irvine Department of Orthopedic Surgery, Orange, CA, USA


| Paramveer Birring
University of California, Irvine Department of Orthopedic Surgery, Orange, CA, USA


| William McMaster
University of California, Irvine Department of Orthopedic Surgery, Orange, CA, USA


| Steven Yang
University of California, Irvine Department of Orthopedic Surgery, Orange, CA, USA


| David So
University of California, Irvine Department of Orthopedic Surgery, Orange, CA, USA
نشانی اینترنتی https://abjs.mums.ac.ir/article_21899.html
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نوع مقاله منتشر شده RESEARCH PAPER
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