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The effect of a split-dose intravenous dexamethasone and a single high-dose on postoperative blood glucose after total joint arthroplasty: a randomized double-blind placebo-controlled trial.
- Source :
-
Journal of orthopaedic surgery and research [J Orthop Surg Res] 2024 Jul 02; Vol. 19 (1), pp. 388. Date of Electronic Publication: 2024 Jul 02. - Publication Year :
- 2024
-
Abstract
- Background: In patients undergoing total joint arthroplasty (TJA), the administration of dexamethasone may contribute to perioperative blood glucose (BG) disturbances, potentially resulting in complications, even in patients without diabetes. This study aimed to demonstrate the impact of different administration regimens of dexamethasone in postoperative BG levels.<br />Methods: In this randomized, controlled, double-blind trial, 136 patients without diabetes scheduled for TJA were randomly assigned to three groups: two perioperative saline injections (Group A, placebo); a single preoperative injection of 20 mg dexamethasone and a postoperative saline injection (Group B), and two perioperative injections of 10 mg dexamethasone (Group C). Primary outcomes were the postoperative fasting blood glucose (FBG) levels. Secondary outcome parameters were the postoperative postprandial blood glucose (PBG) levels. Postoperative complications within 90 days were also recorded. Risk factors for FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl were investigated.<br />Results: Compared to Group A, there were transient increases in FBG and PBG on postoperative days (PODs) 0 and 1 in Groups B and C. Statistical differences in FBG and PBG among the three groups were nearly absent from POD 1 onward. Both dexamethasone regimens did not increase the risk for postoperative FBG ≥ 140 mg/dl or PBG ≥ 180 mg/dl. Elevated preoperative HbA1c levels may increase the risk of postoperative FBG ≥ 140 mg/dl or PBG ≥ 180 mg/dl, respectively.<br />Conclusion: Perioperative intravenous high-dose dexamethasone to patients without diabetes has transient effects on increasing BG levels after TJA. However, no differences were found between the split-dose and single high-dose regimens. The elevated preoperative HbA1c, but not the dexamethasone regimens were the risk factor for FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl.<br />Trial Registration: Chinese Clinical Trail Registry, ChiCTR2300069473. Registered 17 March 2023, https://www.chictr.org.cn/showproj.html?proj=186760 .<br /> (© 2024. The Author(s).)
- Subjects :
- Humans
Double-Blind Method
Male
Female
Middle Aged
Aged
Postoperative Complications prevention & control
Postoperative Complications etiology
Postoperative Complications blood
Injections, Intravenous
Postoperative Period
Arthroplasty, Replacement, Hip adverse effects
Glucocorticoids administration & dosage
Arthroplasty, Replacement adverse effects
Administration, Intravenous
Dexamethasone administration & dosage
Blood Glucose metabolism
Blood Glucose drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1749-799X
- Volume :
- 19
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of orthopaedic surgery and research
- Publication Type :
- Academic Journal
- Accession number :
- 38956678
- Full Text :
- https://doi.org/10.1186/s13018-024-04887-6