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Author Kardash, Kenneth J. ♦ Sarrazin, Frederic ♦ Tessler, Michael J. ♦ Velly, Ana M.
Source World Health Organization (WHO)-Global Index Medicus
Content type Text
Publisher Lippincott Williams & Wilkins
File Format HTM / HTML
Language English
Difficulty Level Medium
Subject Domain (in DDC) Natural sciences & mathematics ♦ Chemistry & allied sciences ♦ Life sciences; biology ♦ Biochemistry ♦ Natural history of organisms ♦ Technology ♦ Medicine & health ♦ Pharmacology and therapeutics ♦ Diseases ♦ Surgery & related medical specialties ♦ Manufacture for specific uses ♦ Precision instruments & other devices
Subject Domain (in MeSH) Eukaryota ♦ Organisms ♦ Nervous System Diseases ♦ Diseases ♦ Organic Chemicals ♦ Polycyclic Compounds ♦ Pharmaceutical Preparations ♦ Chemical Actions and Uses ♦ Chemicals and Drugs ♦ Diagnosis ♦ Therapeutics ♦ Anesthesia and Analgesia ♦ Surgical Procedures, Operative ♦ Investigative Techniques ♦ Analytical, Diagnostic and Therapeutic Techniques and Equipment ♦ Persons ♦ Persons
Subject Keyword Discipline Anesthesiology ♦ Analgesics ♦ Therapeutic Use ♦ Anti-inflammatory Agents ♦ Arthroplasty, Replacement, Hip ♦ Adverse Effects ♦ Dexamethasone ♦ Pain, Postoperative ♦ Prevention & Control ♦ Aged ♦ Aged, 80 And Over ♦ Analgesia, Patient-controlled ♦ Administration & Dosage ♦ Anesthetics, Intravenous ♦ Double-blind Method ♦ Drug Administration Schedule ♦ Female ♦ Humans ♦ Intraoperative Care ♦ Male ♦ Middle Aged ♦ Pain Measurement ♦ Placebos ♦ Postoperative Period ♦ Preoperative Care ♦ Propofol ♦ Journal Article ♦ Randomized Controlled Trial
Abstract BACKGROUND: Preoperative glucocorticoids reduce postoperative nausea but may also improve analgesia and decrease opioid consumption. METHODS: Fifty consecutive patients undergoing elective, unilateral, primary total hip arthroplasty under spinal anesthesia with propofol sedation received in a randomized, double-blind, placebo-controlled manner either 40 mg of dexamethasone or saline placebo i.v. before the start of surgery. I.v. patient-controlled analgesia morphine, ibuprofen 400 mg p.o. q6 h and acetaminophen 650 mg p.o. q6 h were given for 48 h. Pain (0-10 numeric rating scale, NRS) at rest, side effects, and total cumulative patient-controlled analgesia morphine consumption were recorded q4 h for 48 h. Dynamic pain NRS score was recorded at 24 h. C-reactive protein levels were measured in a subgroup of 25 patients at 48 h. RESULTS: The intraoperative sedation requirement with propofol was significantly increased in the dexamethasone group (234.6 +/- 160.1 vs 138.8 +/- 122.7 mg, P = 0.02). Dynamic pain was greatly reduced in the dexamethasone group (NRS score: 2.7, 95% CI: 2.2-3.1 vs 6.8, 6.4-7.2; P < 0.0001). There was no significant effect on pain at rest or cumulative morphine consumption at any time. C-reactive protein levels at 48 h were markedly reduced by dexamethasone (52.4 mg/mL, 28.2-76.6 vs 194.2, 168.9-219.4; P < 0.0001). Seven patients in the control group, but only one in the dexamethasone group, were treated for nausea (P = 0.05). CONCLUSIONS: A single, preoperative i.v. dose of dexamethasone 40 mg has a prolonged suppressive effect on the inflammatory response and decreases dynamic pain 24 h after total hip arthroplasty.
Description Country affiliation: Canada
Author Affiliation: Kardash KJ ( Department of Anesthesia, Sir Mortimer B Davis-Jewish General Hospital, McGill University, Montreal, Canada.
ISSN 00032999
Educational Role Student ♦ Teacher
Age Range above 22 year
Educational Use Reading ♦ Research ♦ Self Learning
Interactivity Type Expositive
Education Level UG and PG
Learning Resource Type Article
Publisher Date 2008-04-01
Publisher Place United States
e-ISSN 15267598
Journal Anesthesia & Analgesia
Volume Number 106
Issue Number 4

Source: WHO-Global Index Medicus