Post-operative Glucocorticoid use in Shoulder Arthroplasty: Early Results of a Randomized-Control Trial
Alexander M Dawes, BS1; Corey C Spencer, BS1; Kevin Xavier Farley, BS1; Charles Andrew Daly, MD1; Michael Gottschalk, MD2; Eric Wagner, MD1
1Emory University, Atlanta, GA; 2Orthopedic Surgery, Emory School of Medicine, Atlanta, GA
Perioperative, IV glucocorticoids have been effectively used for short-term pain management regimen after orthopedic surgeries, mainly in the field of lower extremity arthroplasty. However, there is minimal literature regarding oral postoperative use, and even less information specific to the shoulder. We hypothesize that a Methylprednisolone taper course following total shoulder arthroplasty will reduce pain and opioid consumption in the early postoperative period.
This study is a randomized control trial (NCT03661645) for patients undergoing primary elective total shoulder arthroplasty. Patients are randomly assigned at the time of surgery to receive either intraoperative dexamethasone only or intraoperative dexamethasone followed by a 6-day oral methylprednisolone taper. Postoperative pain and opioid consumption is measured utilizing a pain journal in the first 7 days following surgery. Patient reported functional outcomes and demographics were also recorded.
A total of 35 patients were enrolled from November 2018 to February 2020 with postoperative pain journals. 23 patients have been assigned to the control group and 12 patients have been assigned to the treatment group. There were no differences in age (p=0.66), Body Mass Index (p=0.78), dominant side affected (p=0.41), smoking status (p=0.51), or diabetes (p=0.72). No differences were seen in pre-operative and postoperative patient reported outcomes. In the 7 days following surgery, patients in the control group took an average of 16.2 (±9.3) opioid tablets, while those in the treatment group took an average of 5.4 (±8.9) tablets (p=0.01) (Figure 1). By POD2 there was a significant reduction in the number of cumulative opioid tablets taken. Patient pain was equivalent from POD0 to POD1. However, from POD2 to POD7, patients receiving the methylprednisolone taper reported significantly less pain, with a peak reduction of 3.7 points seen on POD3. On POD7 patients in the treatment group report a mean score of 0.73 compared to 3.3 in the control group (p<0.001) (Figure 2).
The early results of our RCT show that patients receiving a methylprednisolone taper experience significantly less pain in the early postoperative period, and thus, a significant reduction in overall opioid consumption. With no observed increase in the rate of postoperative complications, including surgical site infection, wound complications, or hardware complications, postoperative glucocorticoids appear to be an effective and safe alternative to opioid analgesia.
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