PURPOSE Periarticular infiltration analgesia (PIA) is widely used to control postoperative pain in patients who underwent total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of adding corticosteroids to the PIA cocktail for pain management in patients who underwent TKA. METHODS The patients were randomized to the corticosteroid or control group (double-blind). The patients in the corticosteroid group received a periarticular infiltration of an analgesic cocktail of ropivacaine, epinephrine, and dexamethasone. Dexamethasone was omitted from the cocktail in the control group. The primary outcomes were postoperative pain [assessed using a visual analog scale (VAS)], time until the administration of first rescue analgesia, morphine consumption, and postoperative inflammatory biomarkers [C-reactive protein (CRP) and interleukin-6 (IL-6)]. The secondary outcomes were functional recovery, assessed by the range of knee motion, quadriceps strength, and daily ambulation distance. The tertiary outcomes included postoperative adverse effects. RESULTS The patients in the corticosteroid group had significantly lower resting VAS scores at 6 and 12 h after surgery, lower VAS scores during motion up to 24 h after surgery, and lower levels of inflammatory biomarkers. All the differences in the VAS scores between the two groups did not reach the point to be considered clinically significant. The additional use of corticosteroid significantly prolonged analgesic effects and led to lower rescue morphine consumption. The patients in the corticosteroid group had significantly better functional recovery on the first day after surgery. The two groups had a similar occurrence of adverse effects. CONCLUSIONS Adding corticosteroids to an analgesic cocktail for PIA could lightly improve early pain relief and accelerate recovery in the first 24 h after TKA. LEVEL OF EVIDENCE Randomized controlled trial, Level I.

中文翻译：

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在关节周围浸润镇痛中添加糖皮质激素可改善全膝关节置换术后的短期镇痛效果：一项前瞻性，双盲，随机对照试验。

目的关节周围浸润镇痛（PIA）被广泛用于控制接受全膝关节置换术（TKA）的患者的术后疼痛。这项研究旨在评估在PIA鸡尾酒中添加皮质类固醇对接受TKA的患者进行疼痛治疗的功效。方法将患者随机分为皮质类固醇或对照组（双盲）。皮质类固醇组的患者接受了罗哌卡因，肾上腺素和地塞米松镇痛混合物的关节周围浸润。对照组的鸡尾酒中省略了地塞米松。主要结局为术后疼痛（使用视觉模拟量表（VAS）评估），首次施行急救镇痛的时间，吗啡的消耗，和术后炎症生物标志物[C反应蛋白（CRP）和白介素6（IL-6）]。次要结果是功能恢复，通过膝盖运动范围，股四头肌力量和每日步行距离进行评估。第三结果包括术后不良反应。结果皮质类固醇组的患者术后6和12 h的静息VAS评分显着降低，在运动后直至24 h的运动中VAS评分均较低，并且炎症生物标志物的水平较低。两组之间VAS分数的所有差异均未达到被认为具有临床意义的程度。额外使用皮质类固醇可明显延长镇痛效果，并降低吗啡的抢救量。皮质类固醇组的患者术后第一天的功能恢复明显改善。两组的不良反应发生率相似。结论将皮质类固醇添加到镇痛药中用于PIA可以轻度改善早期疼痛，并在TKA后的最初24小时内加速恢复。证据水平：I级随机对照试验。