Comparing Single Dose and Multiple Dose of Dexamethasone Post TKA

March 24, 2024 updated by: Yot Tanariyakul, Thammasat University Hospital

Efficacy of Intravenous Dexamethasone Injection Given 12 and 24 Hours for Pain After Total Knee Arthroplasty: A Prospective Randomized Clinical Trial

The goal of this clinical trial is to investigate the efficacy of single dose and double dose of dexamethasone after primary total knee replacement.

The main question[s] it aims to answer [is/are]:

Does 24 hours-interval of double dose of dexamethasone have better analgesic effect than single dose and 12 hours interval of double dose of dexamethasone after primary total joint replacement?

Researchers will compare double dose of dexamethasone group to see if [insert effects].

Participants will [describe the main tasks participants will be asked to do, interventions they'll be given and use bullets if it is more than 2 items].

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

  1. Randomized patients into 3 groups

    • Group 1: Patients received only Dexamethasone 0.15 mg/kg IV before surgery.
    • Group 2: Patients received Dexamethasone 0.15 mg/kg IV before surgery and Dexamethasone 0.15 mg/kg at 12 hours after surgery.
    • Group 3: Patients received Dexamethasone 0.15 mg/kg before surgery along and Dexamethasone 0.15 mg/kg at 24 hours after surgery.
  2. Preemptive analgesia Alprazolam 0.5 mg. 1 tablet, Pregabalin 75 mg. 1 tablet before bedtime Celecoxib 400 mg. 1 tablet, Omeprazole 20 mg 1 mg tablet, Paracetamol 500 mg 2 tablets and 1 Ondansetron 4 mg 1 tablet at 1 hour before surgery.
  3. The researcher will give an injection. Dexamethasone 0.15 mg/kg injection form together with Cefazolin 1 gm injection form by the anesthesiologist 30 minutes before surgery.
  4. Spinal Anesthesia by an anesthesiologist before surgery The anesthetic component consists of 0.5% Bupivacaine 15 mg, which does not contain morphine, along with local anesthesia in the thigh area (Adductor canal block) with a mixture of 0.5% Bupivacaine 15 mg.
  5. All patients will undergo knee replacement surgery in the same manner
  6. Periarticular cocktail injection The drug contains Tranexamic acid 10 mg/kg, Morphine 5 mg, Adrenaline 0.5 mg, 5% Bupivacaine 200 mg (Marcaine 1 amp), Ketorolac 30 mg (1 amp) mixed with saline (Normal saline) until 75 ml of area is obtained. The injection site is placed around the knee joint and knee capsule.
  7. After surgery, the patient will stay in the recovery room for 2 hours to take care of their symptoms.

  8. Pain relievers after surgery include

    • Parecoxib (Dynastat) 40 mg injection every 12 hours for the first 2 days after knee replacement surgery, then change the medicine to Celecoxib 400 mg. 1 tablet after breakfast
    • Paracetamol 500 mg. 2 tablets every 6 hours for the first 2 days after knee replacement surgery. After that, give Paracetamol 500 mg. 2 tablets pro for pain every 6 hours
    • Pregabalin 75 mg. 1 tablet po hs
    • Morphine 3 mg injection every 4 hours for patients with a pain score greater than 4 points (VAS-P score ≥4)
    • Ondansetron 4 mg IV prn for nausea and vomitting every 6 hours
    • Alprazolam 0.5 mg 1 tab po hs
    • Cefazolin 1 gm IV every 6 hours for the first 24 hours after surgery
  9. Group 2 patients will receive Dexamethasone 0.15 mg/kg as an injection after surgery at 12 hours, and patients in Group 3 will receive Dexamethasone 0.15 mg/kg as injection at 24 hours after surgery

Study Type

Interventional

Enrollment (Estimated)

120

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Thailand
    • Pathum Thani
      • Khlong Luang, Pathum Thani, Thailand, 12120
        • Recruiting
        • Thammasat University Hospital
        • Principal Investigator:
          • Piya Pinsornsak, M.D.
        • Contact:
        • Principal Investigator:
          • Yot Tanariyakul, M.D.

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Diagnosis of primary osteoarthritis of knee joint
  • Undergo unilateral primary total knee replacement
  • Age between 50-85 years old

Exclusion Criteria:

  • Allergy to dexamethasone
  • History of long term corticosteroid used
  • New York heart association (NYHA) class > II
  • Type 2 Diabetes mellitus that had HbA1c > 7 % or FBS > 200 mg/dl
  • Chronic kidney disease > stage III or eGFR < 60
  • Cirrhosis Child class B or C
  • Cannot use pain controlled as protocol
  • History of previous knee surgery
  • History of previous septic arthritis at knee joint

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Group 1

Preoperative - Dexamethasone 0.15 mg/kg injection by the anesthesiologist 30 minutes before surgery.

Postoperative 12 hr - Normal saline solution injection Postoperative 24 hr - Normal saline solution injection
Drug: Dexamethasone before surgery
Dexamethasone 0.15 mg/kg IV before surgery
Active Comparator: Group 2

Preoperative - Dexamethasone 0.15 mg/kg injection by the anesthesiologist 30 minutes before surgery.

Postoperative 12 hr - Dexamethasone 0.15 mg/kg IV at 12 hours post operation Postoperative 24 hr - Normal saline solution injection
Drug: Dexamethasone before and 12 hours after surgery
Dexamethasone 0.15 mg/kg IV before surgery Dexamethasone 0.15 mg/kg IV at 12 hours post operation
Active Comparator: Group 3

Preoperative - Dexamethasone 0.15 mg/kg injection by the anesthesiologist 30 minutes before surgery.

Postoperative 12 hr - Normal saline solution injection Postoperative 24 hr - Dexamethasone 0.15 mg/kg IV at 24 hours post operation
Drug: Dexamethasone before and 24 hours after surgery
Dexamethasone 0.15 mg/kg IV before surgery Dexamethasone 0.15 mg/kg IV at 24 hours post operation

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Pain at rest and motion
Time Frame: At 6 hour, 12 hour, 18 hour, 24 hour, 30 hour, 36 hour, 42 hour, 48 hour, 54 hour, 60 hour, 66 hour and 72 hour after surgery
Using visual analog scale 0-10 (0 means best, 10 means worst)
At 6 hour, 12 hour, 18 hour, 24 hour, 30 hour, 36 hour, 42 hour, 48 hour, 54 hour, 60 hour, 66 hour and 72 hour after surgery

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Nausea and vomiting
Time Frame: At 24 hour, 48 hour and 72 hour after surgery
Using visual analog scale 0-10 (0 means best, 10 means worst)
At 24 hour, 48 hour and 72 hour after surgery
Morphine consumption
Time Frame: At 24 hour, 48 hour and 72 hour after surgery
Total milligrams use of morphine postoperative (record in mg)
At 24 hour, 48 hour and 72 hour after surgery
Blood sugar level
Time Frame: At 24 hour and 48 hour after surgery
record in mg/dL
At 24 hour and 48 hour after surgery
CRP level
Time Frame: At 24 hour and 48 hour after surgery
record in mg/dL
At 24 hour and 48 hour after surgery
Range of motion
Time Frame: At 24 hour and 48 hour after surgery
Using long arm goniometer (record in degrees)
At 24 hour and 48 hour after surgery
Length of hospital stay
Time Frame: up to 1 week
Number of days the patient stays for surgery
up to 1 week
Complication
Time Frame: up to 6 months
Surgical site infection, deep infection or wound complication
up to 6 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Thammasat University Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

March 23, 2024

Primary Completion (Estimated)

October 31, 2025

Study Completion (Estimated)

October 31, 2025

Study Registration Dates

First Submitted

March 24, 2024

First Submitted That Met QC Criteria

March 24, 2024

First Posted (Actual)

April 1, 2024

Study Record Updates

Last Update Posted (Actual)

April 1, 2024

Last Update Submitted That Met QC Criteria

March 24, 2024

Last Verified

March 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • TUH multiple dexamethasone TKA

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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