title: Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. Perioperative Dexamethasone Does Not Affect Functional Outcome in Total Hip Arthroplasty Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials The effective dose of dexamethasone for antiemesis after major gynecological surgery. Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial. Methylprednisolone intravenously 1 day after surgery has sustained analgesic and opioid‐sparing effects Single-Dose Dexamethasone Reduces Dynamic Pain After Total Hip Arthroplasty Dexamethasone reduces length of hospitalization and improves postoperative pain and nausea after total joint arthroplasty: a prospective, randomized controlled trial. Risk of infectious complications in patients taking glucocorticosteroids. Effects of dexamethasone in preventing postoperative emetic symptoms after total knee replacement surgery: a prospective, randomized, double-blind, vehicle-controlled trial in adult Japanese patients. Effects of steroids on thrombogenic markers in patients undergoing unilateral total knee arthroplasty: a prospective, double-blind, randomized controlled trial. Steroid modulation of cytokine release and desmosine levels in bilateral total knee replacement: a prospective, double-blind, randomized controlled trial. Use of Low-Dose Steroids in Decreasing Cytokine Release During Bilateral Total Knee Replacement Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: A case study of 325 patients The Effect of Perioperative Corticosteroids in Total Hip Arthroplasty: A Prospective Double-Blind Placebo Controlled Pilot Study.
abstract: BACKGROUND High-dose glucocorticoid may reduce postsurgical pain  and improve recovery . We hypothesized that 125 mg methylprednisolone ( MP ) would reduce time to meet functional discharge criteria after total hip arthroplasty ( THA ) . METHODS Forty-eight patients undergoing unilateral THA under spinal anaesthesia were consecutively included in this r and omized , double-blind , placebo-controlled trial receiving preoperative i.v . MP or saline . All patients received a st and ardized , multimodal analgesic regime with paracetamol , celecoxib , and gabapentin . The primary outcome was time to meet well-defined functional discharge criteria . Secondary outcomes were h and grip strength and endurance , pain , nausea , vomiting , fatigue , sleep quality , and rescue analgesic- , antiemetic- , and hypnotic medicine requirements . The inflammatory response measured by C-reactive protein ( CRP ) and actual length of stay were also registered . Discharge criteria were assessed twice daily ( at 09:00 and 14:00 h ) until discharge . Other outcomes were assessed at 2 , 4 , 6 , 8 , and 24 h after operation , and also in a question naire from postoperative day ( POD ) 1 - 4 . RESULTS Time to meet discharge criteria was [ median ( IQR ) ( 95 % CI ) , MP vs placebo ] : 23.5 ( 23.3 - 23.7 ) ( 17.8 - 43.8 ) vs 23.5 ( 23.0 - 23.8 ) ( 20.0 - 46.8 ) h , the mean difference ( 95 % CI ) being -1.3 ( -4.7 to 2.2 ) h , P=0.65 . Overall pain for the first 24 h after surgery was significantly reduced in the MP vs the placebo group ( P<0.01 ) , as was CRP at 24 h ( P<0.0001 ) . No other between-group differences were observed . No drug-related complications were observed at follow-up on POD30 . CONCLUSIONS MP 125 mg i.v . before surgery added to a multimodal oral analgesic regime did not reduce time to meet functional discharge criteria after THA , but improved analgesia for the first 24 Abstract Current trends in orthopaedic surgery have explored different forms of adjuvant treatments to minimize postoperative pain and the risk of nausea and vomiting . A small single preoperative dose of dexamethasone , as part of a comprehensive multimodal analgesic regimen in low-risk patients undergoing total hip arthroplasty ( THA ) , provides antiemetic and opioid-sparing effects but the longer-term effects on pain , complications , or function are not known . We therefore asked whether such a routine would affect longer-term pain , complications , or function . Fifty patients undergoing elective primary THA using spinal anesthesia were initially r and omized to receive either dexamethasone ( 40 mg intravenous ) or saline placebo . The patients , anesthesiologists , nurses , and research coordinators were blinded to the study arms . The functional outcome was measured using the Harris hip score . Outcomes were assessed 6 weeks and 1 year postoperatively . We observed no difference in resting pain between the two groups at either time period . Both groups had similar functional outcome scores for the total Harris hip score and individual scoring items at each followup interval . There were no wound complications , deep infections , or osteonecrosis in the contralateral hip at 1-year followup . We recommend the addition of a small single preoperative dose of dexamethasone to a comprehensive multimodal analgesic regimen in low-risk patients given its immediate antiemetic and opioid-sparing effects , and absence of subsequent effects . Level of Evidence : Level II , therapeutic study ( prospect i ve comparative study ) . See the Guidelines for Authors for a complete description of levels of evidence Background Dexamethasone is a potent analgesic and antiemetic . However , the benefit of dexamethasone after TKA is unclear , as is the efficacy in a current multimodal regime . Questions / purpose sWe determined ( 1 ) whether the addition of dexamethasone to a protocol including ramosetron further reduces postoperative emesis compared with ramosetron alone ; ( 2 ) whether it reduces postoperative pain ; and ( 3 ) whether it increases the risk for wound complications in a current multimodal regime after TKA . Methods We r and omized 269 patients undergoing TKAs to receive dexamethasone ( 10 mg ) 1 hour before surgery and ramosetron  immediately after surgery ( Dexa-Ra  group , n = 135 ) , or  ramosetron alone ( Ra group , n = 134 ) . We recorded the incidence of postoperative nausea and vomiting ( PONV ) , severity of nausea , incidence of antiemetic requirement , complete response , pain level , and opioid consumption . Patients were assessed 0 to 6 , 6 to 24 , 24 to 48 , and 48 to 72 hours postoperatively . In addition , patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery . Results The Dexa-Ra group had a lower incidence of PONV during the entire 72-hour evaluation period and experienced less severe nausea for the first 6 hours after TKA , although not between 6 to 72 hours . Overall use of a rescue antiemetic was less frequent , and complete response was more frequent in the Dexa-Ra group . Patients in the Dexa-Ra group experienced lower pain and consumed less opioids during the 6- to 24-hour period and during the overall study period . No differences were found in wound complications between the groups , and each group had one case of periprosthetic joint infection . Conclusions Patients who received prophylactic dexamethasone in addition to ramosetron had reduced postoperative emesis and pain without increased risks for wound complications , compared with patients who received ramosetron alone in patients managed using a multimodal regimen after TKA.Level of Evidence Level I , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more UNLABELLED This double-blind , r and omized , placebo-controlled study evaluated the minimum effective dose of dexamethasone for postoperative antiemesis .  One-hundred fifty women scheduled for major gynecological surgery were r and omly assigned to receive dexamethasone 10 mg ( D10 ) , 5 mg ( D5 ) , 2.5 mg ( D2.5 ) , 1.25 mg ( D1.25 ) , or placebo ( P ) before the induction of general anesthesia . A st and ardized general anesthesia technique was used . Postoperative pain was treated with bolus IV doses of morphine via a patient-controlled analgesia device . Patients were assessed for incidence of vomiting at 4 , 8 , 12 , and 24 h after surgery . A total of 6 , 6 , 8 , 15 , and 19 patients in Groups D10 , D5 , D2.5 , D1.25 , and Group P experienced vomiting at least once within the first postoperative 24 h , respectively . Dexamethasone 10 mg , 5 mg , and 2.5 mg was more effective than dexamethasone 1.25 mg or placebo for antiemesis ( P < 0.05 ) . The difference in antiemetic effect among the 10 mg , 5 mg , and 2.5 mg groups was similar . The results suggest that 2.5 mg is the minimum effective dose of dexamethasone for postoperative antiemesis in patients undergoing general anesthesia for major gynecological surgery . IMPLICATION S Although dexamethasone is effective for antiemesis , major side effects may accompany its perioperative use . To achieve the best antiemesis with the fewest side effects , dexamethasone 10 mg , 5 mg , 2.5 mg , and 1.25 mg were compared with placebo in surgical patients . We found 2.5 mg to be the minimum effective dose without discernible side effects BACKGROUND Total knee arthroplasty ( TKA ) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach , but the effect of high-dose glucocorticoid administration has not been studied . METHODS Forty-eight patients undergoing unilateral TKA were included in a r and omized , double-blind , placebo-controlled trial receiving preoperative methylprednisolone ( MP ) 125 mg i.v . or saline . All surgery was performed under lumbar spinal anaesthesia and patients received a st and ardized , multimodal analgesic regime . The primary endpoint was pain during walking 24 h after surgery , and secondary endpoints were pain at rest , pain upon hip flexion , and pain upon knee flexion . Pain assessment s were performed repeatedly for the first 48 h after surgery , in a question naire from days 2 to 10 , and at follow-up on days 21 and 30 . Tertiary endpoints were postoperative nausea and vomiting ( PONV ) , plasma C-reactive protein ( CRP ) concentrations , fatigue , sleep quality , and rescue analgesic and antiemetic requirements . RESULTS Pain during walking was significantly lower in the MP group up to 32 h after operation . Overall pain and cumulative pain scores ( 2 - 48 h ) were lower for all pain assessment s ( P<0.04 ) . Consumption of rescue oxycodone  was lower from 0 to 24 h ( P=0.02 ) and PONV , consumption of ondansetron  reduced ( P<0.05 ) , and CRP concentrations were lower at 24 h ( P<0.000001 ) . Fatigue throughout the day of surgery was lower ( P=0.02 ) , but sleep quality was worse on the first night ( P=0.002 ) . No side-effects or complications were observed in other respects . CONCLUSIONS MP 125 mg before surgery improves analgesia and immediate recovery after TKA , even when combined with a multimodal analgesic regime . These findings call for further studies on safety aspects Background : In previous studies on glucocorticoids for  postoperative pain  , the test drug has been given perioperatively , usually before measurement of baseline pain . In order to evaluate the time course and magnitude of the analgesic effect of a glucocorticoid in well‐established postoperative pain , we compared methylprednisolone with ketorolac and placebo , after assessment of baseline pain on the first postoperative day BACKGROUND : Preoperative glucocorticoids reduce postoperative nausea but may also improve analgesia and decrease opioid consumption . METHODS : Fifty consecutive patients undergoing elective , unilateral , primary total hip arthroplasty under spinal anesthesia with propofol sedation received in a r and omized , double-blind , placebo-controlled manner either 40 mg of dexamethasone or saline placebo IV before the start of surgery . IV patient-controlled analgesia morphine , ibuprofen 400 mg po q6 h and acetaminophen 650 mg po q6 h were given for 48 h. Pain ( 0–10 numeric rating scale , NRS ) at rest , side effects , and total cumulative patient-controlled analgesia morphine consumption were recorded q4 h for 48 h. Dynamic pain NRS score was recorded at 24 h. C-reactive protein levels were measured in a subgroup of 25 patients at 48 h. RESULTS : The intraoperative sedation requirement with propofol was significantly increased in the dexamethasone group ( 234.6 ± 160.1 vs 138.8 ± 122.7 mg , P = 0.02 ) . Dynamic pain was greatly reduced in the dexamethasone group ( NRS score : 2.7 , 95 % CI : 2.2–3.1 vs 6.8 , 6.4–7.2 ; P < 0.0001 ) . There was no significant effect on pain at rest or cumulative morphine consumption at any time . C-reactive protein levels at 48 h were markedly reduced by dexamethasone ( 52.4 mg/mL , 28.2–76.6 vs 194.2 , 168.9–219.4 ; P < 0.0001 ) . Seven patients in the control group , but only one in the dexamethasone group , were treated for nausea ( P = 0.05 ) . CONCLUSIONS : A single , preoperative IV dose of dexamethasone 40 mg has a prolonged suppressive effect on the inflammatory response and decreases dynamic pain 24 h after total hip arthroplasty Controlling postoperative pain and nausea after total joint arthroplasty remains an important challenge . We conducted a prospect i ve , r and omized controlled trial with 120 patients to determine if the addition of perioperative dexamethasone to a multimodal regimen improves antiemetic and analgesic control , enhances mobility , and shortens hospital length of stay after total hip and knee arthroplasty . Patients administered 10 mg of intravenous dexamethasone intraoperatively consumed less daily rescue anti-emetic and analgesic medication , reported superior VAS nausea and pain scores , ambulated further distances , and had a significantly shorter length of stay compared to the control group ( P<0.05 ) . A second , 24-hour postoperative dose of 10 mg intravenous dexamethasone provided significant additional pain and nausea control and further reduced length of stay ( P<0.05 ) . No adverse events were detected with the administration of the intraoperative and /or postoperative dexamethasone The association between corticosteroid therapy and subsequent infections was calculated by pooling data from 71 controlled clinical trials . The overall rate of infectious complications was 12.7 % in the 2,111 patients r and omly allocated to systemic corticosteroids  and 8.0 % in the 2,087 controls  ( relative risk [ RR ] , 1.6 ; 95 % confidence interval [ CI ] , 1.3 - 1.9 ; P less than .001 ) . The risk of infection was particularly high in patients with neurologic diseases ( RR , 2.8 ; 95 % CI , 1.9 - 4.3 ; P less than .001 ) and less pronounced in patients with intestinal ( RR , 1.4 ; 95 % CI , 1.1 - 1.7 ; P = .02 ) , hepatic ( RR , 1.4 ; 95 % CI , 0.9 - 2.3 ; P = .25 ) , and renal ( RR greater than 1 ; P = .03 ) diseases . The rate was not increased in patients given a daily dose of less than 10 mg or a cumulative dose of less than 700 mg of prednisone . With increasing doses the rate of occurrence of infectious complications increased in patients given corticosteroids as well as in patients given placebo , a finding suggesting that not only the corticosteroid but also the underlying disease state account for the steroid-associated infectious complications observed in clinical practice BACKGROUND Postoperative emetic symptoms ( nausea , retching , and vomiting ) are common following total joint replacement , with an incidence as high as 83 % when no prophylactic antiemetic is provided . However , most antiemetics currently used in Japan , such as antihistamines ( eg , hydroxyzine ) , butyrophenones ( eg , droperidol ) , and dopamine receptor antagonists ( eg , metoclopramide ) , have been associated with adverse effects ( AEs ) , such as excessive sedation , hypotension , dry mouth , dysphoria , hallucinations , and extrapyramidal symptoms . OBJECTIVE The aim of this study was to assess the efficacy and tolerability of 3 doses of intravenous dexamethasone monotherapy versus vehicle in preventing emetic symptoms after total knee replacement performed under combined general and epidural anesthesia . METHODS This prospect i ve , r and omized , double-blind , vehicle-controlled trial was conducted at the Department of Anesthesiology , University of Tsukuba Institute of Clinical Medicine , Tsukuba , Japan . Adult Japanese patients scheduled to undergo total knee replacement were eligible . Patients were r and omly assigned to 1 of 4 treatment groups : dexamethasone 4 , 8 , or 16 mg , or vehicle ( control ) . Patients received combination anesthesia with sevoflurane and nitrous oxide in pure oxygen ( general ) and lidocaine ( epidural ) . Study drugs were administered intravenously after the completion of surgery . An investigator blinded to treatment assignment monitored patients for emetic symptoms for 24 hours after the patient awoke . Patients rated their satisfaction with the study drug using a linear , 11-point scale ( 0 = complete satisfaction to 10 = complete dissatisfaction ) . Tolerability was assessed by the study investigator using spontaneous reporting and patient interview . RESULTS A total of 80 patients were enrolled ( 58 women , 22 men ; mean [ SD ] age , 59 [ 10 ] years ; mean [ SD ] height , 154 [ 7 ] cm ; mean [ SD ] body weight , 55 [ 7 ] kg ; 20 patients per treatment group ) . The demographic , clinical , and surgical data were comparable between the 4 treatment groups . The rates of emesis-free patients were 35 % ( 7 patients ) , 70 % ( 14 ) , and 75 % ( 15 ) with dexamethasone 4 , 8 , and 16 mg , respectively , compared with 30 % ( 6 ) with vehicle ( P = NS , 0.013 , and 0.005 , respectively ) . Median ( range ) patient satisfaction scores were significantly higher in the groups receiving dexamethasone 8 and 16 mg ( both , 0.0 [ 0 - 9 ] ) compared with controls ( 6.0 [ 0 - 10 ] ) ( P = 0.013 and 0.008 , respectively ) . This effect was not found with the 4-mg dose . No clinical ly serious AEs attributed to the study drug were observed in any of the 4 treatment groups . CONCLUSIONS In this study of a small , select group of adult Japanese patients undergoing total knee replacement , the rates of emesis-free patients were higher with dexamethasone 8 and 16 mg compared with vehicle 24 hours after anesthesia induction . This effect was not found with the 4-mg dose . All treatments were well tolerated Venous thromboembolism ( VTE ) remains an important complication after total knee arthroplasty ( TKA ) . Systemic thrombin generation starts perioperatively . Inflammation , characterized by a rise in interleukin-6 ( IL6 ) , initiates the coagulation cascade , but low-dose steroids can reduce post-TKA IL6 levels . This double-blinded , r and omized , placebo-controlled study enrolled 30 patients undergoing unilateral TKA to assess the effect of perioperative steroids on serum prothrombin fragment ( PF1.2 ) , a marker of thrombin generation , and plasmin-alpha-2-antiplasmin complex ( PAP ) , a marker of fibrinolysis . Study patients received 100 mg of intravenous hydrocortisone 2 h prior to surgery , and controls received normal saline . Blood sample s , drawn pre-incision and at 4 h post tourniquet release , were assayed for PF1.2 and PAP . The study group had significantly lower mean PF1.2 at 4 h compared to controls ( 616 ± 358 pMol/L vs. 936 ± 332 pMol/L , p = 0.037 ) . The mean rise in PF1.2 in the control group was significantly greater compared to the study group ( 672 ± 173 pMol/L vs. 350 ± 211 pMol/L , p < 0.001 ) . Mean PAP was higher in the study group at 4 h ( 1639 ± 823 µg/L vs. 1087 ± 536 µg/L ) , but did not reach statistical significance ( p = 0.07 ) . These results may have clinical implication s in terms of postoperative VTE risk and management BACKGROUND The perioperative inflammatory response as measured by elevated levels of interleukin-6 ( IL-6 ) has been linked to acute respiratory distress syndrome , postoperative confusion , and fever . Because of the extent of surgery , patients undergoing bilateral total knee arthroplasty may be at high risk of complications . We had found a significant decrease in IL-6 in patients having bilateral total knee replacement who received two doses of 100 mg of hydrocortisone eight hours apart ; however , by twenty-four hours , IL-6 levels were equal to those in the group that received a placebo . In the present study , we investigated whether the administration of three doses would reduce IL-6 levels at twenty-four hours and affect other outcomes such as desmosine level , a marker of lung injury . METHODS After institutional review board approval , a total of thirty-four patients ( seventeen patients and seventeen control subjects ) were enrolled in this double-blind , r and omized , placebo-controlled study . Three doses of intravenous hydrocortisone ( 100 mg ) or placebo were given eight hours apart . Urinary desmosine levels were obtained at baseline and at one and three days postoperatively . The level of IL-6 was measured at baseline and at six , ten , twenty-four , and forty-eight hours postoperatively . Pain scores , presence of fever , and functional outcomes were recorded . RESULTS The level of IL-6 increased in both groups , but was significantly higher in the control group , peaking at twenty-four hours ( mean and st and ard deviation , 623.74 ± 610.35 pg/mL versus 148.13 ± 119.35 pg/mL ; p = 0.006 ) . Urinary desmosine levels significantly increased by twenty-four hours in the control group , but remained unchanged in the study group ( 134.75 ± 67.88 pmol/mg and 79.45 ± 46.30 pmol/mg , respectively ; p = 0.006 ) . Pain scores at twenty-four hours were significantly lower in the study group ( 1.4 ± 0.9 versus 2.4 ± 1.2 ; p = 0.01 ) as was the presence of fever ( 11.8%versus 47.1 % ; p = 0.03 ) . Range of motion at the knee was significantly greater in the study group ( 81.6 ± 11.6 versus 70.6 ± 14.0 in the right knee [ p = 0.02 ] and 81.4 ± 11.3 versus 73.4 ± 9.4 in the left knee [ p = 0.03 ] ) . CONCLUSIONS Hydrocortisone ( 100 mg ) given over three doses , each eight hours apart , decreased and maintained a lower degree of inflammation with bilateral total knee replacement as measured by IL-6 level . Corticosteroids decreased the prevalence of fever , lowered visual analog pain scores , and improved knee motion . The significantly lower values of desmosine in the study group suggest that this treatment may be protective against lung injury Background : Interleukin 6 ( IL-6 ) , a marker of inflammation , is one of the major cytokines released during joint replacement . In the orthopedic patient population , high levels have been linked to many adverse effects including acute respiratory distress syndrome , postoperative mental status changes , and fever . We looked to assess the efficacy of low-dose steroids on the postinflammatory response as measured by IL-6 in patients undergoing bilateral total knee replacement ( BTKR ) . The role of steroids has never been evaluated before in that setting . Methods : Double-blind , r and omized , placebo-controlled study of 30 patients undergoing BTKR . The study was powered in order to detect at least a 25 % decrease in IL-6 from control . Hydrocortisone ( 100 mg ) or placebo was given at 2 doses 8 hrs apart to the study and control group respectively . Clinical outcome was assessed as well . Results : Levels of IL-6 were 40 % lower in the study group by 10 hrs ( P = 0.0037 ) but were similar to the control group at 24 hrs . Greater hemodynamic stability was noted in the study group with fewer episodes of hypotension postoperatively ( P = 0.031 ) . Range of motion gained on discharge was also greatest in the study group ( P = 0.049 ) . Absence of infection and normal wound healing were noted in all patients . Conclusions : The use of hydrocortisone significantly decreased the inflammatory response in patients undergoing BTKR as measured by IL-6 production . Further studies looking at clinical implication s of such findings in a larger patient population and with a longer course of steroids are warranted Background We have developed a multimodal technique for the control of pain  following knee and hip surgery , called " local infiltration analgesia " ( LIA ) . It is based on systematic infiltration of a mixture of ropiva-caine , ketorolac , and adrenaline into the tissues around the surgical field to achieve satisfactory pain control with little physiological disturbance . The technique allows virtually immediate mobilization and earlier discharge from hospital . Patients and methods In this open , nonr and omized case series , we used LIA to manage postoperative pain in all 325 patients presenting to our service from Jan 1 , 2005 to Dec 31,2006 for elective hip resurfacing ( HRA ) , primary total hip replacement ( THR ) , or primary total knee replacement arthroplasty ( TKR ) . We recorded pain scores , mobilization times , and morphine usage for the entire group . Results Pain control was generally satisfactory ( numerical rating scale pain score range 0–3 ) . No morphine was required for postoperative pain control in two-thirds of the patients . Most patients were able to walk with assistance between 5 and 6 h after surgery and independent mobility was achieved 13–22 h after surgery . Orthostatic hypotension , nausea , and vomiting were occasionally associated with st and ing for the first time , but other side effects were unremarkable . 230 ( 71 % ) of the 325 patients were discharged directly home after a single overnight stay in hospital . Interpretation Local infiltration analgesia is simple , practical , safe , and effective for pain management after knee and hip surgery BACKGROUND Surgery produces a rapid rise in interleukin 6 ( IL-6 ) which may increase the risk of deep vein thrombosis and medical complications . Perioperative corticosteroids suppress IL-6 release in patients undergoing total knee arthroplasty . This study evaluates the effects of a perioperative corticosteroid regimen on IL-6 formation , thrombogenesis , fibrinolysis , and clinical outcomes in patients undergoing unilateral , uncemented , total hip arthroplasty . METHODS Twenty-seven patients ( 14 placebo and 13 study ) were enrolled in this r and omized , double-blind , placebo-controlled trial . The study group received 20 mg of prednisone orally followed by 2 doses of intravenous hydrocortisone , each 8 hours apart . Blood was drawn at several time points for IL-6 , prothrombin fragment 1.2 , and plasmin-alpha-2-antiplasmin complex , a marker of fibrinolysis . In-hospital visual analog pain ( visual analog scale ) scores , patient-controlled analgesia use , and ability to climb stairs were recorded . RESULTS Mean serum IL-6 levels at 6 and 24 hours postoperatively were significantly lower for the study group , whereas serum prothrombin fragment 1.2 and plasmin-alpha-2-antiplasmin were not statistically different at any study time point . Average pain scores were similar ( P > .05 ) , but study group experience less severe pain ( P < .01 ) and less patient-controlled analgesia ( P = .02 ) . At 3 months , 4 patients in the placebo and 1 patient in the study group had difficulty going up and down staircases ( P = .08 ) . CONCLUSION The use of corticosteroids was associated with a statistically significant decrease in IL-6 at 6 and 24 hours postoperatively but did not affect thrombogenic markers . The study group had improved postoperative analgesia and a trend toward improved functional outcome at 3 months postoperatively
target: Meta- analysis showed that high-dose systemic steroid ( dexamethasone > 0.1 mg/kg ) rather than low dose is effective to reduce postoperative nausea and vomiting and postoperative acute pain ( within 24 h ) .
  In addition , systemic steroid is associated within faster functional rehabilitation and greater inflammation control .
  On the other h and , systemic steroid is associated with a higher level of postoperative serum glucose on the operation day .
  Conclusions Our study suggests that by providing lower incidence of postoperative nausea and vomiting and less postoperative acute pain , high-dose systemic steroid plays a critical role in rapid recovery to TKA and THA .
  The preliminary results also show the superior possibility of systemic steroid in functional rehabilitation and inflammation control .
background: Background Perioperative systemic steroid administration for rapid recovery in total knee and hip arthroplasty ( TKA/THA ) is an important and controversial topic .
  We conducted this systematic review and meta- analysis to evaluate the overall benefits and harms of perioperative systemic steroid in patients undergoing TKA and THA .