The effect of pre-operative high doses of methylprednisolone on pain management and convalescence after total hip replac
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ORIGINAL PAPER
The effect of pre-operative high doses of methylprednisolone on pain management and convalescence after total hip replacement in elderly: a double-blind randomized study Artur Gądek 1,2 & Henryk Liszka 2,3
&
Małgorzata Zając 2,4,5
Received: 31 March 2020 / Accepted: 4 September 2020 # The Author(s) 2020
Abstract Purpose The aim of the study was to assess whether administration of a single dose of methylprednisolone in the group patients above 65 years of age will be effective in complex analgesic management after total hip arthroplasty (THA). Methods Seventy-seven patients above 65 years old were double-blind randomized into two: the study and controls groups. Preoperatively, the study group received as a single dose of 125 mg intravenous methylprednisolone, while the others saline solution as placebo. Peri-operatively, all the patients were administered opioid and nonopioid analgesic agents. We measured the levels of inflammatory markers (leukocytosis, C-reactive protein—CRP), pain intensity level (visual analog scale—VAS; numerical rating scale—NRS), the life parameters, and noted complications. Results Following administration of methylprednisolone were significantly lower levels of CRP on all the four post-operative days; leukocytosis on the second day; the VAS/NRS score at rest after six, 12, and 18 hours post-operatively, diminished the dose of parenteral opioid preparations (oxycodone hydrochloride), the duration of analgesia by peripheral nerve block was significantly higher as compared with the placebo group (p < 0.000001). No infectious complications were noted; there was one patient who developed post-operative delirium. Conclusion A single dose of methylprednisolone significantly reduces the level of post-operative pain at rest on the day of THA in the group patients above 65 years of age, decreases the dose of opioid analgesic agents, and significantly decreases the level of inflammatory markers, without infectious processes. Keywords Total hip joint replacement . Methylprednisolone . Opioid dose . Pain intensity . Infection rate
Introduction Total hip and knee arthroplasties are associated with considerable pain between the sixth and 24th post-operative hour
* Henryk Liszka [email protected] 1
Department of Orthopedics and Physiotherapy, Jagiellonian University Collegium Medicum, Krakow, Poland
2
Department of Orthopedics and Traumatology, University Hospital in Krakow, Krakow, Poland
3
Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
4
Department of Anaesthesiology and Intensive Care, Jagiellonian University Collegium Medicum, Krakow, Poland
5
Department of Anaesthesiology and Intensive Care, University Hospital in Krakow, Krakow, Poland
[1–3]. The surgical incision, as a mechanical factor, affects the nociceptor, initiates the pain process, and triggers numerous inflammatory mediators [1, 4, 5]. The Enhanced Recovery After Surgery (ERAS) with the method multimodal analgesia accelerates the patient’s returning to full activity [4–10]
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