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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EStudy data was presented in this article demonstrate that patients who receive preemptive low-dose dexamethasone prior to total knee arthroplasty (TKA) have a reduced incidence of postoperative pain, nausea, and vomiting [Koh IJ et al. \u003Cem\u003EClin Orthop Relat Res\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EStudy data was presented by In Jun Koh, MD, Uijeongbu St. Mary\u0027s Hospital, Seoul, Republic of Korea, demonstrating that patients who receive preemptive low-dose dexamethasone prior to total knee arthroplasty (TKA) have a reduced incidence of postoperative pain, nausea, and vomiting [Koh IJ et al. \u003Cem\u003EClin Orthop Relat Res\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAlthough TKA is one of the most effective treatments for advanced knee arthritis, many patients suffer significant pain due to the procedure, as well as postoperative nausea and vomiting (PONV) associated with anesthesia and analgesia. Yet despite the potential clinical benefits of using low-dose dexamethasone to manage these symptoms, there remains little data on its use in this setting. This study therefore set out to compare the preemptive addition of low-dose dexamethasone with a multimodal protocol including the antiemetic ramosetron (Dexa-Ra), with ramosetron alone (Ra). It aimed to determine whether preemptive Dexa-Ra would lead to improved reduction in PONV and additional analgesic effect, and whether dexamethasone increased the risk for wound complications in these patients.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EPatients undergoing TKA (n=269) were randomized to Dexa-Ra (dexamethasone 10 mg 1 hour before surgery, and ramosetron immediately post operatively; n=135), or Ra alone (n=134), and were evaluated 0 to 6, 6 to 24, 24 to 48, and 48 to 72 hours after surgery. Symptoms were scored using a 0 to 10 visual analog scale (VAS). At a minimum of 1 year post TKA, patients were also assessed for wound complications and periprosthetic joint infections.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIncidence of PONV was the primary outcome. Secondary outcomes were complete response, pain level, severity of nausea, and incidence of wound complications in addition to use of rescue antiemetics and opioid consumption.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EDuring the 72-hour evaluation period, Dexa-Ra administration was associated with a reduced incidence of postoperative nausea (24% vs 40%; p=0.004), vomiting (7% vs 21%; p=0.001), and use of rescue antiemetics (17% vs 35%; p=0.001), as well as an increased complete response (76% vs 60%; p=0.006), compared with administration of Ra alone. Patients in the Dexa-Ra group also experienced less severe nausea during the first 6 hours (1.6 vs 2.6; p\u0026lt;0.001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). However, there was no significant difference in the incidence of PONV or nausea between the treatment groups from 6 to 72 hours.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/2\/13.2\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Postoperative Nausea Severity\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-679872216\u0022 data-figure-caption=\u0022Postoperative Nausea Severity\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/2\/13.2\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/2\/13.2\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/2\/13.2\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15649\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EPostoperative Nausea Severity\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EDexa-Ra=low-dose dexamethasone with ramosetron; R=ramosetron alone; VAS=visual analog scale.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Koh IJ et al. Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study. \u003Cem\u003EClin Orthop Relat Res.\u003C\/em\u003E 2013;471:3010\u20133020. With permission from Springer.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EDexa-Ra was also associated with less pain (mean VAS pain score 2.4 vs 4.0; p\u0026lt;0.001), and opioid consumption (73.5 vs 128.3 \u03bcg; p\u0026lt;0.001) from 6 to 24 hours, and reduced overall opioid consumption during the entire 72-hour period (406.2 vs 500.1 \u03bcg; p=0.004).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThere was no significant difference in wound complications (1.5% vs 2.2%; p\u0026gt;0.1) between the groups, and one patient in each group had periprosthetic joint infection (0.7% vs 0.7%; p\u0026gt;0.1).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EProf. Koh concluded that the use of dexamethasone in multimodal protocols offers a simple, effective, and inexpensive means of reducing pain and PONV following TKA, without apparent increased risk of wound complications or infection. He stressed, however, that more clinical trial data would be necessary to further evaluate the effect of dexamethasone on wound complications or infection in these patients.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/2\/13.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzpcf2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzpcf2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}