Effectiveness of Intravenous Dexamethasone plus Adductor Canal Block VS Adductor Canal Block Alone to Prolong Analgesia Following Total Knee Arthroplasty: A Randomized Controlled Trial
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Abstract
BACKGROUND: Total knee arthroplasty (TKA) is the standard treatment for patients with advanced knee osteoarthritis. At Rayong Hospital, the number of patients undergoing TKA is increasing annually, making it the most common elective surgery. Effective postoperative pain control is essential to enhance recovery and reduce complications. A common approach involves spinal anesthesia without morphine combined with an adductor canal block (ACB). However, some patients still experience inadequate pain relief.
OBJECTIVE: To evaluate the effectiveness of intravenous Dexamethasone combined with ACB compared to ACB alone for postoperative pain management in patients undergoing TKA.
METHODS: This study was a double-blind randomized controlled trial. Sixty-four patients undergoing elective TKA were randomly assigned to two groups (32 patients each). All patients received spinal anesthesia without morphine and ACB. Group 1 received Dexamethasone intravenously, while Group 2 received normal saline intravenously. Data were collected at the time to first morphine request, total morphine consumption within the first 24 hours postoperatively, and VAS pain scores at rest as well as during movement at 0, 6, 12, 18, and 24 hours postoperatively.
RESULTS: The mean time to first morphine request was 646.5 minutes in the Dexamethasone group and 595 minutes in the normal saline group—a difference of 51.5 minutes, which was not statistically significant. However, total morphine consumption within the first 24 hours was significantly lower in the Dexamethasone group (3 mg) compared to the normal saline group (6 mg) (p<0.05). VAS pain scores at rest and during movement were significantly lower in the Dexamethasone group at 18 hours postoperatively (p<0.05).
CONCLUSIONS: Intravenous Dexamethasone combined with adductor canal block (ACB) significantly reduced opioid consumption within the first 24 hours postoperatively and lowered VAS pain scores at 18 hours. Moreover, pain scores at rest and during movement remained below 3.
Thaiclinicaltrials.org number, TCTR20240428001
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