Periarticular Administration of Dexamethasone to Improve Post-operative Pain, Function, Nausea, Hospitalization Length, and Risk of Complications in Patients Undergoing Hip Arthroplasty - A Randomized Trial
概览
- 阶段
- 4 期
- 干预措施
- Dexamethasone is a steroid drug and will be administered as an injectable solution (4mg/ml)
- 疾病 / 适应症
- Femoral Neck Fractures
- 发起方
- Ente Ospedaliero Cantonale, Bellinzona
- 入组人数
- 110
- 试验地点
- 1
- 主要终点
- Postoperative pain
- 状态
- 招募中
- 最后更新
- 上个月
概览
简要总结
The investigators are going to evaluate if periarticular corticosteroid injection during endoprothesis implantation can lead to any advantage to the patients, namely if it can reduce post-operative pain, lenght and cost of hospitalisation, use of analgesics drugs.
详细描述
Hip endoprothesis is a common orthopaedic prosthetic procedure, with continuously growing numbers in the last years, and the demand for this procedure is predicted to increase 4-fold by 2030. Recently, major interest has been given to improve postoperative pain management, to decrease the discomfort of the patients and with an outlook for reducing the length of hospital stay and decrease health-care costs. However, postoperative pain management is still problematic after this operation. Post-operative pain control with the optimization of the analgesia protocol is a key aspect to be addressed to reduce the need for opioid analgesics, to quicken recovery and mobilisation, and to decrease the hospitalization length. To this regard, steroid supplementation is considered effective in decreasing post-operative pain. A recent meta-analysis from our research group on patients with total knee prosthesis proved the efficacy in decreasing post-operative pain. Moreover, a positive effect has been documented in terms of lower incidence of nausea and vomit, less post-operative range of motion limitation, and decreased systemic inflammatory response. All these benefits produced a shortened length of hospital stay without an increased risk of complications such as local infections. Despite this overall positive effect of steroid supplementation, and their use by other specialties - e.g. anaesthesiology - and while there is now good evidence about the benefits of periarticular hip analgesic injection, e.g. FANS, opioid etc., there is still lacking evidence on the efficacy of periarticular corticosteroids in patients undergoing hip prosthetic replacement. In fact, there is a lack of information in the literature on their effectiveness in terms of pain management and function recovery. Furthermore, the influence of perioperative steroid application on the long-term follow-up results is poorly explored. This is a key issue, since the intensity of acute post-operative pain has been widely related to the risk of developing chronic post-operative pain, and thus the advantages of steroid supplementation, could go beyond the short-term pain relief and be even longer lasting. This randomized controlled trial will thus investigate the benefit of implementing the peri-operative analgesia protocol not only to improve the acute post-operative recovery and shorten the hospital stay, but also to optimize the overall results after hip endoprosthesis.
研究者
Christian Candrian
Principal Investigator
Ente Ospedaliero Cantonale, Bellinzona
入排标准
入选标准
- •Patients undergoing unilateral cemented hip endoprosthesis for femoral neck fracture
- •Patients aged 50-90 years old
- •Patients with a BMI \>18.5 and \<35
- •Patients able to provide informed consent and follow all the study procedures as indicated by the protocol
- •Informed Consent as documented by signature
排除标准
- •Contraindications to steroids
- •Revision endoprosthesis
- •Active steroid or immunosuppressive therapy in the last 30 days before the operation
- •Pregnant or breast-feeding women
- •Presence of other clinically significant concomitant disease states (ASA IV)
- •Uncontrolled diabetes mellitus
- •Contraindications to NSAIDs
- •Chronic systemic diseases as immunodeficiency, autoimmune disease (Systemic Lupus Erythematosus, SLE), gout, rheumatic arthritis
- •Known or suspected non-compliance, drug or alcohol abuse
- •Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc. of the participant.
研究组 & 干预措施
Dexamethasone group
Patient in this group will receive administration of 9 mg dexamethasone injected in the peri-articular tissues after the bone cut for hip endoprosthesis
干预措施: Dexamethasone is a steroid drug and will be administered as an injectable solution (4mg/ml)
Routine care
In this group only routinely performed anaesthesia protocol will be provided
结局指标
主要结局
Postoperative pain
时间窗: 3 days after surgery
The mean post-operative daily pain in the first three days after surgery assessed with the 0-10 numeric rating scale (NRS)
次要结局
- Hip pain, function and quality of life on EQ-5D-5L Score(Up to 24 months)
- PCR & ESR(3 days after surgery)
- Length of hospital stay(Up to week 2)
- Hip pain and function on a numeric rating scale (NRS)(Up to 24 months)
- Hip pain, function and quality of life on Harris Hip Score(Up to 24 months)
- PainDETECT(Up to 24 months)
- Nausea(3 days after surgery)
- Mobilization(Up to week 2)
- Opioids and analgesic(Up to 24 months)
- Patient Satisfaction(reported on a 0-10 NRS at 2 and 6 weeks, 3, 6, 12, 24 months)
- Hip ROM(evaluation of range of motion preoperatively, at discharge and at 2 and 6 weeks, and at 3, 6, 12, 24 months postoperatively.)