A systematic review and meta-analysis on how different dexamethasone administration regimes impact total joint arthroplasty outcomes

Can Wang¹Chenjing Luo¹Xiaoxue Tang¹Li Luo¹Yuerong Zeng²Yumei Zhang^3*Xuan Wang^1*

• ¹Department of Pharmacy, The Second Affiliated Hospital of Army Medical University, Chongqing, China
• ²Department of Pharmacy, Chongqing General Hospital, Chongqing, Chongqing, China
• ³Department of Orthopedics, The Second Affiliated Hospital of Army Medical University, Chongqing, China

Background: Postoperative pain following total joint arthroplasty is a critical factor influencing patient recovery. This meta-analysis evaluated the efficacy and safety of single-dose, repeated-dose, and split-dose perioperative dexamethasone regimens for managing postoperative pain in patients undergoing total joint arthroplasty.Methods: Randomized controlled studies (RCTs) comparing repeated or splitdexamethasone to single intravenous dexamethasone in patients having total knee/hip arthroplasty were retrieved from Pubmed, the Cochrane Library, Web of Science and Embase databases from inception to October 2024. Using RevMan 5.2, a metaanalysis was performed to evaluate primary outcomes including pain scores, length of stay, and incidence of postoperative rescue analgesia, as well as secondary outcomes such as the incidence of adverse events. Heterogeneity was assessed via I² statistics, and study bias was evaluated using the Cochrane Risk of Bias Assessment Tool.Results: Twelve trials were included. The results showed that repeated-dose dexamethasone did not differ from single-dose dexamethasone in rest or movement pain scores at 24 hours, but significantly reduced both rest (mean difference [MD]= -0.45, 95% confidence interval [CI]: -0.62 to -0.29, P < 0.00001, I 2 = 41%) and movement (MD= -0.69, CI: -0.83 to -0.55, P < 0.00001, I 2 = 36%) pain scores at 48 hours. They also had shorter stays (MD = -0.28, 95% CI: -0.47 to -0.09, P =0.004, I 2 = 71%), lower rates of needing postoperative rescue analgesia (relative risk[RR]=0.26, 95% CI: 0.11 to 0.63, P =0.003, I 2 = 72%) and postoperative nausea and vomiting [PONV] (RR = 0.47, 95% CI: 0.24 to 0.95, P = 0.04, I 2 = 60%). Moreover, patients receiving a single dose of dexamethasone had lower movement scores 24 hours postoperatively (MD = 0.26, 95% CI: 0.03 to 0.48, P = 0.02, I 2 = 61%) compared to patients with a split-dose of dexamethasone. No significant differences in adverse event rates were observed between single-dose and split-dose dexamethasone.Compared to patients receiving a single-dose or split-dose of dexamethasone, the administration of repeated doses of dexamethasone can mitigate postoperative pain, reduce the requirement for supplementary opioids, shorten the duration of hospitalization, and decrease the incidence of PONV following arthroplasty.