Thread by @Siva6faces

1/ A 68 yr old lady with h/o HTN, HLD, DM for left TKR. Pre-op celebrex, meloxicam and an adductor canal block with iPACK block. Spinal anesthesia for intra-op. How much intravenous dexamethasone would you administer? @KalagaraHari @EMARIANOMD @SreeHPraveenKO1 @dr_rajgupta

2/ In our practice, most patients receive 4mg or 8mg of intravenous dexamethasone. Is one dose better than the other - more effective or lesser side-effects?
We did a retrospective study find an answer:
cureus.com/articles/39235…

3/ Dexamethasone is a potent long acting, synthetic corticosteroid. Concerns with intra-op dexamethasone include hyperglycemia, altered immune response & delayed wound healing. doi.org/10.1111/aas.12…
Is there an optimal dose to harness benefits without undesirable side-effects?

4/ Primary reasons for our use of intraoperative dexamethasone as part of a multimodal regimen for:
a. PONV prophylaxis
b. Post-op analgesia
Other benefits have been reported.
arthroplastyjournal.org/article/S0883-…

5/ Consensus guidelines recommend 4mg dexamethasone as an optimal dose for PONV prophylaxis:
…bmed-ncbi-nlm-nih-gov.online.uchc.edu/24356162/
Is 4mg adequate for post-op analgesia, as part of a multimodal regimen?

6/ What is the role of dexamethasone in post-op analgesia?
Studies here suggest doses in the range of 10mg or 0.1mg/kg may be needed for analgesic effects.
journals.lww.com/md-journal/Ful…
doi.org/10.1093/bja/ae…

7/ Was there a difference between 4mg vs 8mg doses in Hyperglycemia?
Both doses increased the blood sugar but the difference was not significant.
The proportion of patients requiring Insulin between the two groups was not high either (5.46% in 8mg vs 7.43 in 4mg)

8/ Does dexamethasone increase the incidence of complications in diabetes?
Literature does not seem to suggest that:
# journals.lww.com/anesthesia-ana…
# arthroplastyjournal.org/article/S0883-…

9/ Limitations of our study:
1. Retrospective study
2. Could not standardize time of administration or measurements
3. Eliminated significant number of patients to avoid confounding factors (different dose, multiple doses)
4. Could not study direct impact on analgesia

10/ Conclusions:
# 4mg dexamethasone may be adequate for PONV prophylaxis but 8mg or higher may be needed for analgesia
# Dexamethasone should not be withheld for the fear of hyperglycemia or risk of infection
cureus.com/articles/39235…

An attempt at a #tweetorial
@afedwardMD @DrMStiegler @BurgartBioethix @VeenaGraffMD @jeffsimmons @Happy_hypoxia @Ropivacaine @rakesh6282 @shaskinsMD @ssinha3300 @SLKoppMD @vkurup42 @KukrejaPromil @amit_pawa @GottumukVijaya @jeffgadsden @hariharan_shank @ASRA_Society @MKwesiKwofie

@CureusInc

doi.org/10.1093/bja/ae…