Perioperative combined administration of tranexamic acid and dexamethasone in total knee arthroplasty-benefit versus harm?

Background: The purpose of this study was to investigate the benefits and harm of combined administration of tranexamic acid (TXA) and dexamethasone (Dexa) in total knee arthroplasty (TKA). Methods: A total of 88 consecutive patients undergoing TKA for knee osteoarthritis were stratified in 2 groups. All surgeries were performed under general anesthesia. Brief, patients in the TXA + Dexa group (n=45) received 10mg Dexa just after the anesthesia, and repeated at 24hours after the surgery; and patients in the TXA group (n=43) received 2ml of normal saline solution at the same time. The measured outcomes were the C-reactive protein (CRP) and interleukin-6 (IL-6) from preoperatively to postoperatively, and postoperative nausea and vomiting (PONV), fatigue, range of motion (ROM), length of stay (LOS), and the analgesic and antiemetic rescue consumption Results: The level of CRP and IL-6 in the TXA + Dexa group were lower than that in the TXA group at 24hours (P < .001, P < .001), 48hours (P < .001, P < .001), and 72hours (P < .001, P < .001) after the surgery. The pain scores in the TXA + Dexa group were lower during walking at 24hours (P < .001), 48hours (P < .001), and 72hours (P < .001) and at rest at 24hours (P=.022) after the surgery. Patients in the TXA + Dexa group had a lower nausea score, the incidence of PONV, fatigue, and the analgesic and antiemetic rescue consumption, and had a greater ROM than that in the TXA group. No significant differences were found in LOS and complications. Conclusion: The combined administration of TXA + Dexa significantly reduced the level of postoperative CRP and IL-6, relieve postoperative pain, ameliorate the incidence of POVN, provide additional analgesic and antiemetic effects, reduce postoperative fatigue, and improve ROM, without increasing the risk of complications in primary TKA.