Friday, October 30, 2026

1:20 PM - 1:26 PM

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Overview

Greg Janes

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Details

Aim Dexamethasone is widely used as part of multimodal perioperative analgesia for total knee arthroplasty (TKA), with low-dose intravenous regimens (typically 8 mg) established for prevention of postoperative nausea and vomiting. Higher perioperative doses have been proposed to extend anti-inflammatory and opioid-sparing benefits into the early recovery period, with reported reductions in opioid consumption, pain, and length of stay. The optimal dose remains uncertain, and questions persist regarding the safety of higher-dose regimens. Following introduction of a high-dose dexamethasone protocol at our institution, we sought to compare pain and functional outcomes before and after implementation, and to identify any adverse events associated with the protocol. Methods A retrospective audit of patient records was undertaken, comparing 40 patients following implementation of a high-dose dexamethasone protocol (DEX) compared to 40 patients prior to (CON), and. Inclusion was restricted to unilateral primary TKA. The mean intraoperative dose in the DEX group was 0.84 mg/kg actual body weight. Outcomes were oral morphine equivalent (OME) opioid use at 24, 48 and 72 hours postoperatively, highest recorded numerical rating scale (NRS) pain scores, active knee flexion, and ability to complete a 10-metre walk test at the same time points. Post-operative physiotherapy discharge day and Hospital length of stay (LOS) was also recorded. Continuous data were analysed using Student's t-test or Mann-Whitney U test as appropriate; categorical data were analysed using Chi-squared or Fisher's exact test. A linear mixed-effects model was fitted to adjust for between-group differences in patient-controlled analgesia (PCA) use. Results Baseline demographics were comparable between cohorts. PCA use was higher in the pre-protocol group (47.5% vs 22%). After adjustment for PCA use, 24-hour OME opiod used was lower in the DEX group (104.3 mg [95% CI 89 mg to 120 mg] vs 138 mg [95% CI 123 mg to 154 mg], p=0.002). No differences were observed at 48 or 72 hours. NRS pain scores did not differ at any time point. Functional outcomes favoured the DEX group, with greater day 1 knee flexion (78° vs 63°, p<0.001), a higher proportion completing a 10-metre walk on day 1 (97% vs 50%, p<0.001), earlier physiotherapy discharge (median 2 vs 3 days, p=0.002), and shorter HLOS (median 3 vs 4 days, p=0.008). No serious adverse events were identified in either cohort. Conclusion Introduction of a high-dose perioperative dexamethasone protocol was associated with lower early opioid consumption and meaningful improvements in early functional recovery following TKA, with no detectable difference in reported pain scores and no adverse events. These findings provide preliminary effect size estimates to support a planned randomised controlled trial, in which a functional outcome will be considered as the primary endpoint.