A prospective, randomized, controlled trial has found that a single preoperative dose of betamethasone significantly reduces postoperative nausea and vomiting (PONV) in patients undergoing total knee arthroplasty (TKA). The study, published in Frontiers in Medicine, suggests that betamethasone could be a valuable prophylactic treatment to improve patient recovery after TKA.
The increasing demand for TKA is often complicated by PONV, which can significantly hinder patient recovery and satisfaction. While glucocorticoids have shown promise in alleviating PONV in other surgical contexts, their efficacy in TKA patients has been unclear. This study aimed to evaluate the efficacy and safety of preoperative betamethasone for PONV in TKA patients.
Study Design and Methods
The trial involved 124 patients undergoing TKA, randomly assigned to receive either 2 mL of normal saline (control group) or 2 mL of betamethasone sodium phosphate (10.52 mg total dose; experimental group) 10 minutes before anesthesia induction. The primary outcomes assessed were nausea severity, vomiting frequency, and antiemetic use. Secondary outcomes included pain scores, knee range of motion, blood glucose levels, inflammatory markers (IL-6, CRP, ESR), and adverse reactions.
Key Findings
The experimental group exhibited significantly lower nausea severity scores at 2, 4, 6, 12, and 24 hours post-surgery compared to the control group. The average frequency of vomiting was also significantly lower in the betamethasone group (0.060 ± 0.307) compared to the control group (0.390 ± 0.662, P < 0.001). Furthermore, the postoperative use of metoclopramide, a rescue antiemetic, was significantly reduced in the betamethasone group (0.480 ± 2.163) compared to the control group (4.520 ± 6.447, P < 0.001).
Inflammatory Response
Analysis of inflammatory markers revealed that CRP levels on the second postoperative day were significantly lower in the betamethasone group (45.741 ± 47.044) compared to the control group (65.235 ± 50.970, P = 0.014). Similarly, IL-6 levels were lower in the betamethasone group on both the first (51.853 ± 67.202 vs. 79.477 ± 97.441, P = 0.039) and second postoperative days (25.143 ± 31.912 vs. 38.618 ± 36.282, P = 0.006).
Safety Profile
No significant differences were observed between the two groups in terms of postoperative knee pain, knee range of motion, blood glucose levels, ESR, or adverse reactions, indicating a favorable safety profile for preoperative betamethasone.
Clinical Implications
The study's findings suggest that preoperative betamethasone is an effective and safe intervention for reducing PONV in TKA patients. This approach offers a new clinical strategy for the prophylactic treatment of PONV following TKA, potentially improving patient comfort and recovery.
