Affiliation:
1. Department of Orthopedics Qilu Hospital of Shandong University Jinan China
2. Shandong University Cheeloo College of Medicine Jinan China
3. Department of Anaesthesiology, Qilu Hospital Shandong University Jinan China
4. Department of Cardiology, the Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, the State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Qilu Hospital of Shandong University Jinan China
5. Institute for In Vitro Sciences Gaithersburg MD USA
Abstract
ObjectivesDespite the use of multimodal analgesia, patients undergoing knee arthroplasty still encounter residual moderate pain. The addition of betamethasone to local anesthetic has been shown to improve postoperative pain. However, it remains uncertain whether the positive effects of perineural or intravenous administration of betamethasone on analgesia outcomes lead to better early mobility and postoperative recovery.MethodsBetween June 2022 and February 2023, a total of 159 patients who were undergoing knee arthroplasty were included in this study. These patients were allocated randomly into three groups: (i) the NS group, received ropivacaine 0.375% and intravenous 3mL 0.9% normal saline; (ii) the PNB group, received ropivacaine 0.375% plus perineural betamethasone (12mg) 3mL and intravenous 3mL 0.9% normal saline; and (iii) the IVB group, received ropivacaine 0.375% and intravenous betamethasone (12mg) 3mL.ResultsBoth perineural and intravenous administration of betamethasone led to improved median (IQR) numeric rating scale (NRS) scores on the 6‐meter walk test, with a score of 1.0 (1.0–2.0) for both groups, compared with 2.0 (1.0–2.0) for the NS group (p = 0.003). Compared to the NS group, both the PNB and IVB groups showed significant reductions in NRS scores at 24 and 36 h after surgery, along with a significant increase in ROM at 24, 36, and 48 h post‐operation. Additionally, it exhibited lower levels of cytokine IL‐1β and TNF‐α in fluid samples, as well as lower level of HS‐CRP in blood samples in the PNB and IVB groups compared to the NS group.ConclusionThe administration of perineural and intravenous betamethasone demonstrated an enhanced analgesic effect following knee arthroplasty. Furthermore, it was associated with reduced levels of IL‐1β, TNF‐α, and HS‐CRP, as well as enhanced knee ROM, which is conducive to early ambulation and postoperative rehabilitation after knee arthroplasty.
Funder
China Postdoctoral Science Foundation