Abstract：
BACKGROUND: Glucocorticoids have been widely used in perioperative period for postoperative pain relief after total knee arthroplasty (TKA). However, the optimal administration protocols of glucocorticoids remain controversial. This study aims to compare the efficacy of glucocorticoids between intravenous and periarticular injection on clinical outcomes.
METHODS: A total of 114 patients were randomly assigned to intravenous (IV) group (n = 57) and periarticular injection (PI) group (n = 57). The IV group received 10 mg dexamethasone intravenously and the PI group received periarticular injection of 10 mg dexamethasone during the procedure. The clinical outcomes were assessed using visual analogue scale (VAS), knee society score (KSS), range of motion (ROM), knee swelling, inflammation markers and complications after TKA.
RESULTS: The VAS score during walking at 2nd day postoperatively was lower in the PI group compared with the IV group (2.08 ± 1.45 vs 2.73 ± 1.69, p = .039), and there was no significant difference at the other time points of VAS score in two groups. The inflammation markers, knee swelling, knee ROM and KSS score were not statistically different. Vomiting and other complications occurrence were not significantly different between the two groups.
CONCLUSIONS: Intraoperative periarticular injection of glucocorticoids has similar analgesic effect compared to intravenous in the postoperative period following TKA and may be even more effective on the second postoperative day. In addition, periarticular injection of glucocorticoids does not impose an excess risk or complication on patients.
METHODS: A total of 114 patients were randomly assigned to intravenous (IV) group (n = 57) and periarticular injection (PI) group (n = 57). The IV group received 10 mg dexamethasone intravenously and the PI group received periarticular injection of 10 mg dexamethasone during the procedure. The clinical outcomes were assessed using visual analogue scale (VAS), knee society score (KSS), range of motion (ROM), knee swelling, inflammation markers and complications after TKA.
RESULTS: The VAS score during walking at 2nd day postoperatively was lower in the PI group compared with the IV group (2.08 ± 1.45 vs 2.73 ± 1.69, p = .039), and there was no significant difference at the other time points of VAS score in two groups. The inflammation markers, knee swelling, knee ROM and KSS score were not statistically different. Vomiting and other complications occurrence were not significantly different between the two groups.
CONCLUSIONS: Intraoperative periarticular injection of glucocorticoids has similar analgesic effect compared to intravenous in the postoperative period following TKA and may be even more effective on the second postoperative day. In addition, periarticular injection of glucocorticoids does not impose an excess risk or complication on patients.
摘要：
背景：糖皮质激素已广泛用于围手术期，以缓解全膝关节置换术（TKA）后的术后疼痛。然而,糖皮质激素的最佳给药方案仍存在争议.这项研究旨在比较静脉和关节周围注射糖皮质激素对临床结局的疗效。
方法：将114例患者随机分为静脉（IV）组（n=57）和关节周围注射（PI）组（n=57）。IV组静脉注射10mg地塞米松，PI组在手术过程中接受关节周围注射10mg地塞米松。采用视觉模拟评分法(VAS)评估临床结局,膝盖社会得分（KSS），运动范围（ROM），膝盖肿胀,TKA后的炎症指标和并发症。
结果：与IV组相比，PI组术后第2天步行时的VAS评分较低（2.08±1.45vs2.73±1.69，p=0.039），两组在其他时间点的VAS评分差异无统计学意义。炎症标志物，膝盖肿胀,膝关节ROM和KSS评分无统计学差异。两组患者术后呕吐等并发症发生率差异无统计学意义。
结论：与TKA术后静脉内注射相比，术中关节周围注射糖皮质激素具有相似的镇痛效果，并且在术后第二天可能更有效。此外,关节周围注射糖皮质激素不会给患者带来额外的风险或并发症。
方法：将114例患者随机分为静脉（IV）组（n=57）和关节周围注射（PI）组（n=57）。IV组静脉注射10mg地塞米松，PI组在手术过程中接受关节周围注射10mg地塞米松。采用视觉模拟评分法(VAS)评估临床结局,膝盖社会得分（KSS），运动范围（ROM），膝盖肿胀,TKA后的炎症指标和并发症。
结果：与IV组相比，PI组术后第2天步行时的VAS评分较低（2.08±1.45vs2.73±1.69，p=0.039），两组在其他时间点的VAS评分差异无统计学意义。炎症标志物，膝盖肿胀,膝关节ROM和KSS评分无统计学差异。两组患者术后呕吐等并发症发生率差异无统计学意义。
结论：与TKA术后静脉内注射相比，术中关节周围注射糖皮质激素具有相似的镇痛效果，并且在术后第二天可能更有效。此外,关节周围注射糖皮质激素不会给患者带来额外的风险或并发症。
