Comparison of intravenous and periarticular administration of dexamethasone in total knee arthroplasty

Purpose: Corticosteroids are widely used in total knee arthroplasty (TKA) to ameliorate post-operative pain. This study compared the effects of intravenous administration (IVA) and periarticular injection (PAI) of dexamethasone on pain, nausea, and blood glucose levels following TKA. Methods: An institutional database was used to retrospectively examine two cohorts of patients who had undergone unilateral TKA from August 2018 to September 2020. The IVA group (n ​= ​50) received 10 ​mg dexamethasone 1 ​h before surgery and 24 ​h after surgery. The PAI group (n ​= ​50) received 10 ​mg dexamethasone during surgery. Pain scores at rest and during walking as well as nausea scores were recorded using the 0–10 numerical rating scale after surgery. Fasting blood glucose (FBG) levels were measured post-operatively. Results: A total of 100 patients were enrolled (mean age, 71 years; 86% female). The rest pain score 24 ​h post-operatively was significantly lower in the PAI group than in the IVA group (3.3 vs. 4.3; absolute difference 1.0, 95% confidence interval, 0.4–1.3; P ​= ​0.007). The nausea score did not differ markedly between groups. FBG was significantly higher in the PAI group than in the IVA group in the morning of post-operative Day 1. Conclusion: PAI with dexamethasone was found to control pain more effectively at 24 ​h than IVA. FBG on the morning of post-operative Day 1 was significantly higher in the PAI group. Level of evidence, III; retrospective cohort.