Effect Of Intraoperative Intravenous And Local Injection Of Glucocorticoid On The Early Clinical Outcomes After Total Knee Arthroplasty

Objective:Glucocorticoids are widely used in orthopedic perioperative period because of their analgesic and anti-inflammatory effects.However,the ideal administration method of glucocorticoids has not been conclusive.This study will compare the clinical effects of intraoperative intravenous injection and periarticular injection of glucocorticoids on the early stage after total knee arthroplasty,and determine whether intraoperative intravenous injection of glucocorticoids is similar to periarticular injection of glucocorticoids in reducing the pain after total knee arthroplasty.In addition,this study will compare the two administration methods of glucocorticoids in reducing opioids,the incidence of postoperative nausea and vomiting,knee swelling,inflammatory indicators,improving the early postoperative joint range of motion and shortening the length of hospital stay,and determine their safety according to the incidence of postoperative complications.Method:163 patients who were hospitalized in the Department of Joint Osteopathy and Trauma of Guangdong Provincial People ’s Hospital and scheduled for unilateral total knee arthroplasty from June 2020 to June 2021 were enrolled in this study.After screening by inclusion and exclusion criteria,114 patients were finally included in the study and randomly divided into two groups.Among them,the intravenous group received 10 mg dexamethasone intravenously before intraoperative implantation of the prosthesis,while a cocktail without dexamethasone was infiltrated and injected at multiple points around the knee joint.In the periarticular injection group,a cocktail containing 10 mg dexamethasone was instilled at multiple points around the knee joint before implantation of the prosthesis,along with 10 ml of 5%glucose and sodium chloride solution was injected intravenously.Under the premise that other multimodal analgesia regimens were the same in perioperative period,the main outcome measures were visual analog score(VAS)of pain at 6 h after operation,1～4 days after operation,2 weeks after operation and 3 months after operation.Secondary outcome measures included the degree of postoperative knee joint swelling,knee range of motion,knee function score,inflammatory indicators,other laboratory indicators,incidence of nausea and vomiting,and incidence of postoperative complications.Results:Finally,103 patients(51 in the intravenous group and 52 in the periarticular injection group)were included in the statistical analysis.The VAS score of walking state on the second day after operation in the periarticular injection group(2.08 ± 1.45)was lower than that in the intravenous group(2.73 ± 1.96),and the difference between the two groups had statistical significance(P<0.05).However,there was no statistically significant difference in VAS scores measured at other postoperative time points between the two groups.Fasting blood glucose on postoperative day 1 in periarticular injection group(7.26±2.02 mmol/L)was higher than that in intravenous group(6.19 ± 1.21 mmol/L),and there was significant difference between the two groups(P<0.05).There was no significant difference in the degree of knee joint swelling,range of motion,knee joint function score,inflammatory indicators,other laboratory indicators,incidence of nausea and vomiting and incidence of postoperative complications between the intravenous group and the periarticular injection group.Conclusion:Compared with the intravenous group,periarticular injection of glucocorticoid-containing cocktails around the joint during surgery has certain advantages in the analgesic effect in the early weight-bearing state after total knee arthroplasty.However,the effects of intravenous group and periarticular injection group were similar in terms of overall analgesic effect,inflammatory indicators,knee swelling,knee range of motion,knee function score and postoperative complications after total knee arthroplasty.