Trial Outcomes & Findings for Dexamethasone and Pain Following Total Knee Arthroplasty (NCT NCT02271698)

NCT ID: NCT02271698

Last Updated: 2018-02-20

Results Overview

Pain scores at rest and with activity using a verbal rating scales (VRS) of 0-10, where "0" represents no pain and "10" represents worst pain ever.

Recruitment status

COMPLETED

Study phase

PHASE4

Target enrollment

45 participants

Primary outcome timeframe

6, 12, 18, 24, 36 hours after surgery

Results posted on

2018-02-20

Participant Flow

45 participants signed consent. 3 participants withdrew prior to randomization

Participant milestones

Participant milestones
Measure
Dexamethasone 6mg
Patients receive 6mg iv dexamethasone at surgical incision and a repeat dose of 6mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 12mg
Patients receive 12mg iv dexamethasone at surgical incision and a repeat dose of 12mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 24mg
Patients receive 24mg iv dexamethasone at surgical incision and a repeat dose of 24mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Placebo
Patients receive a placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Placebo: Placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision.
Overall Study
STARTED
11
10
10
11
Overall Study
COMPLETED
11
10
10
11
Overall Study
NOT COMPLETED
0
0
0
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Dexamethasone and Pain Following Total Knee Arthroplasty

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Dexamethasone 6mg
n=11 Participants
Patients receive 6mg iv dexamethasone at surgical incision and a repeat dose of 6mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 12mg
n=10 Participants
Patients receive 12mg iv dexamethasone at surgical incision and a repeat dose of 12mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 24mg
n=10 Participants
Patients receive 24mg iv dexamethasone at surgical incision and a repeat dose of 24mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Placebo
n=11 Participants
Patients receive a placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Placebo: Placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision.
Total
n=42 Participants
Total of all reporting groups
Age, Continuous
68.06 years
STANDARD_DEVIATION 8.74 • n=5 Participants
66.56 years
STANDARD_DEVIATION 8.32 • n=7 Participants
64.14 years
STANDARD_DEVIATION 6.43 • n=5 Participants
69.45 years
STANDARD_DEVIATION 5.45 • n=4 Participants
67.13 years
STANDARD_DEVIATION 7.35 • n=21 Participants
Sex: Female, Male
Female
7 Participants
n=5 Participants
4 Participants
n=7 Participants
4 Participants
n=5 Participants
8 Participants
n=4 Participants
23 Participants
n=21 Participants
Sex: Female, Male
Male
4 Participants
n=5 Participants
6 Participants
n=7 Participants
6 Participants
n=5 Participants
3 Participants
n=4 Participants
19 Participants
n=21 Participants

PRIMARY outcome

Timeframe: 6, 12, 18, 24, 36 hours after surgery

Population: Participants who completed pain score at specified time-points.

Pain scores at rest and with activity using a verbal rating scales (VRS) of 0-10, where "0" represents no pain and "10" represents worst pain ever.

Outcome measures

Outcome measures
Measure
Dexamethasone 6mg
n=11 Participants
Patients receive 6mg iv dexamethasone at surgical incision and a repeat dose of 6mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 12mg
n=10 Participants
Patients receive 12mg iv dexamethasone at surgical incision and a repeat dose of 12mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 24mg
n=9 Participants
Patients receive 24mg iv dexamethasone at surgical incision and a repeat dose of 24mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Placebo
n=11 Participants
Patients receive a placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Placebo: Placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision.
Change in Visual Analogue Pain Score
6 hour at rest
3.09 units on a scale
Standard Deviation 1.45
4.80 units on a scale
Standard Deviation 2.20
3.56 units on a scale
Standard Deviation 2.74
5.5 units on a scale
Standard Deviation 2.54
Change in Visual Analogue Pain Score
6 hour with movement
4.36 units on a scale
Standard Deviation 2.42
6.50 units on a scale
Standard Deviation 3.10
5.88 units on a scale
Standard Deviation 2.47
7.33 units on a scale
Standard Deviation 1.80
Change in Visual Analogue Pain Score
12 hour at rest
2.82 units on a scale
Standard Deviation 1.99
3.50 units on a scale
Standard Deviation 1.96
2.78 units on a scale
Standard Deviation 1.86
5.18 units on a scale
Standard Deviation 2.99
Change in Visual Analogue Pain Score
12 hour with movement
5.75 units on a scale
Standard Deviation 2.25
6.11 units on a scale
Standard Deviation 1.76
6.00 units on a scale
Standard Deviation 2.77
7.30 units on a scale
Standard Deviation 3.23
Change in Visual Analogue Pain Score
18 hour at rest
1.55 units on a scale
Standard Deviation 1.86
2.70 units on a scale
Standard Deviation 2.45
2.56 units on a scale
Standard Deviation 2.40
5.09 units on a scale
Standard Deviation 2.39
Change in Visual Analogue Pain Score
18 hour with movement
4.00 units on a scale
Standard Deviation 3.16
5.43 units on a scale
Standard Deviation 2.99
4.63 units on a scale
Standard Deviation 2.88
6.90 units on a scale
Standard Deviation 3.00
Change in Visual Analogue Pain Score
24 hour at rest
2.91 units on a scale
Standard Deviation 2.34
3.50 units on a scale
Standard Deviation 2.27
3.67 units on a scale
Standard Deviation 2.65
4.09 units on a scale
Standard Deviation 2.84
Change in Visual Analogue Pain Score
24 hour with movement
4.82 units on a scale
Standard Deviation 2.68
6.50 units on a scale
Standard Deviation 2.07
6.38 units on a scale
Standard Deviation 2.33
7.20 units on a scale
Standard Deviation 2.15
Change in Visual Analogue Pain Score
36 hour at rest
3.00 units on a scale
Standard Deviation 2.24
3.86 units on a scale
Standard Deviation 2.54
4.43 units on a scale
Standard Deviation 2.30
2.89 units on a scale
Standard Deviation 1.69
Change in Visual Analogue Pain Score
36 hour with movement
5.29 units on a scale
Standard Deviation 1.60
7.00 units on a scale
Standard Deviation 1.79
6.83 units on a scale
Standard Deviation 2.23
6.33 units on a scale
Standard Deviation 1.94

PRIMARY outcome

Timeframe: 6, 12, 18, 24, 36 hours after surgery

Population: Participants who completed pain score at specified time-points.

mg of morphine equivalents

Outcome measures

Outcome measures
Measure
Dexamethasone 6mg
n=11 Participants
Patients receive 6mg iv dexamethasone at surgical incision and a repeat dose of 6mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 12mg
n=8 Participants
Patients receive 12mg iv dexamethasone at surgical incision and a repeat dose of 12mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 24mg
n=9 Participants
Patients receive 24mg iv dexamethasone at surgical incision and a repeat dose of 24mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Placebo
n=11 Participants
Patients receive a placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Placebo: Placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision.
Change in Opioid Consumption
6 hours
21.10 mg of morphine equivalents
Standard Deviation 15.94
22.20 mg of morphine equivalents
Standard Deviation 23.54
11.77 mg of morphine equivalents
Standard Deviation 11.75
33.50 mg of morphine equivalents
Standard Deviation 21.84
Change in Opioid Consumption
12 hours
42.24 mg of morphine equivalents
Standard Deviation 50.16
27.24 mg of morphine equivalents
Standard Deviation 30.03
54.23 mg of morphine equivalents
Standard Deviation 35.80
32.25 mg of morphine equivalents
Standard Deviation 30.74
Change in Opioid Consumption
18 hours
20.30 mg of morphine equivalents
Standard Deviation 16.77
16.86 mg of morphine equivalents
Standard Deviation 16.93
43.16 mg of morphine equivalents
Standard Deviation 55.34
29.75 mg of morphine equivalents
Standard Deviation 37.12
Change in Opioid Consumption
24 hours
25.50 mg of morphine equivalents
Standard Deviation 15.69
20.91 mg of morphine equivalents
Standard Deviation 17.93
25.86 mg of morphine equivalents
Standard Deviation 14.80
23.79 mg of morphine equivalents
Standard Deviation 21.79
Change in Opioid Consumption
36 hours
27.00 mg of morphine equivalents
Standard Deviation 25.22
24.61 mg of morphine equivalents
Standard Deviation 17.13
36.43 mg of morphine equivalents
Standard Deviation 26.25
21.29 mg of morphine equivalents
Standard Deviation 13.59

SECONDARY outcome

Timeframe: 30 days, 3 and 6 months following surgery

Population: Participants who completed questionnaire

The Western Ontario and McMaster Universities Osteoarthritis Index measures 17 items for functional limitation (score range 0-68). Higher score = higher difficulty with the task.

Outcome measures

Outcome measures
Measure
Dexamethasone 6mg
n=11 Participants
Patients receive 6mg iv dexamethasone at surgical incision and a repeat dose of 6mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 12mg
n=10 Participants
Patients receive 12mg iv dexamethasone at surgical incision and a repeat dose of 12mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 24mg
n=9 Participants
Patients receive 24mg iv dexamethasone at surgical incision and a repeat dose of 24mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Placebo
n=11 Participants
Patients receive a placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Placebo: Placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision.
Change in Functional Status as Measured by Western Ontario and McMaster Universities Osteoarthritis Index
30 Days
25 units on a scale
Interval 18.5 to 34.0
29.5 units on a scale
Interval 21.25 to 38.75
42 units on a scale
Interval 33.0 to 43.0
30 units on a scale
Interval 23.5 to 44.5
Change in Functional Status as Measured by Western Ontario and McMaster Universities Osteoarthritis Index
3 months
17 units on a scale
Interval 12.0 to 23.5
32 units on a scale
Interval 24.5 to 40.25
19 units on a scale
Interval 12.0 to 35.0
24 units on a scale
Interval 12.25 to 33.75
Change in Functional Status as Measured by Western Ontario and McMaster Universities Osteoarthritis Index
6 months
14 units on a scale
Interval 7.5 to 22.5
24.5 units on a scale
Interval 12.75 to 29.5
17 units on a scale
Interval 11.5 to 22.0
16 units on a scale
Interval 9.0 to 23.0

SECONDARY outcome

Timeframe: Baseline at enrollment, 3 months and 6 months after surgery

Population: Participants who completed questionnaire

Brief pain inventory questionnaire will be administered generating a score (0-40). Higher scores reflect higher perceived pain.

Outcome measures

Outcome measures
Measure
Dexamethasone 6mg
n=11 Participants
Patients receive 6mg iv dexamethasone at surgical incision and a repeat dose of 6mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 12mg
n=10 Participants
Patients receive 12mg iv dexamethasone at surgical incision and a repeat dose of 12mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 24mg
n=9 Participants
Patients receive 24mg iv dexamethasone at surgical incision and a repeat dose of 24mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Placebo
n=10 Participants
Patients receive a placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Placebo: Placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision.
Change in Chronic Pain as Measured by Brief Pain Inventory Questionnaire
Baseline
5 units on a scale
Interval 4.0 to 8.0
5 units on a scale
Interval 3.0 to 8.0
5 units on a scale
Interval 2.0 to 6.0
4 units on a scale
Interval 1.75 to 6.0
Change in Chronic Pain as Measured by Brief Pain Inventory Questionnaire
3 months
1 units on a scale
Interval 0.0 to 4.0
0.5 units on a scale
Interval 0.0 to 2.0
2 units on a scale
Interval 0.75 to 3.0
2 units on a scale
Interval 1.0 to 4.0
Change in Chronic Pain as Measured by Brief Pain Inventory Questionnaire
6 months
0 units on a scale
Interval 0.0 to 0.0
2.5 units on a scale
Interval 0.0 to 3.5
1 units on a scale
Interval 0.0 to 2.0
0 units on a scale
Interval 0.0 to 1.25

SECONDARY outcome

Timeframe: Baseline at Enrollment, 3 and 6 months after surgery

Population: Participants who completed questionnaire

Brief pain inventory questionnaire will be administered generating a score (0-70). Higher scores reflect higher perceived pain interference.

Outcome measures

Outcome measures
Measure
Dexamethasone 6mg
n=11 Participants
Patients receive 6mg iv dexamethasone at surgical incision and a repeat dose of 6mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 12mg
n=10 Participants
Patients receive 12mg iv dexamethasone at surgical incision and a repeat dose of 12mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 24mg
n=9 Participants
Patients receive 24mg iv dexamethasone at surgical incision and a repeat dose of 24mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Placebo
n=10 Participants
Patients receive a placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Placebo: Placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision.
Change in Functional Status as Measured by Brief Pain Inventory Questionnaire
Baseline
5 units on a scale
Interval 4.0 to 8.0
5 units on a scale
Interval 3.0 to 8.0
5 units on a scale
Interval 2.0 to 6.0
4 units on a scale
Interval 1.75 to 6.0
Change in Functional Status as Measured by Brief Pain Inventory Questionnaire
3 Months
0 units on a scale
Interval 0.0 to 2.0
5 units on a scale
Interval 2.25 to 8.0
0 units on a scale
Interval 0.0 to 3.0
1.5 units on a scale
Interval 0.0 to 3.0
Change in Functional Status as Measured by Brief Pain Inventory Questionnaire
6 Months
0 units on a scale
Interval 0.0 to 1.0
1 units on a scale
Interval 0.0 to 4.75
0 units on a scale
Interval 0.0 to 1.0
0 units on a scale
Interval 0.0 to 2.0

OTHER_PRE_SPECIFIED outcome

Timeframe: Samples will be taken immediately pre incision and will be repeated at 33-39hours

Macrophage totals and differentiation will be assessed within patients and between groups.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: Sample immediately prior to incision and at 10-14, 22-26 and 33-39hours after surgery.

Interleukin levels and the ratio will assess pro and anti inflammatory processes in the patients

Outcome measures

Outcome data not reported

Adverse Events

Dexamethasone 6mg

Serious events: 0 serious events
Other events: 1 other events
Deaths: 0 deaths

Dexamethasone 12mg

Serious events: 0 serious events
Other events: 2 other events
Deaths: 0 deaths

Dexamethasone 24mg

Serious events: 0 serious events
Other events: 5 other events
Deaths: 0 deaths

Placebo

Serious events: 0 serious events
Other events: 6 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Dexamethasone 6mg
n=11 participants at risk
Patients receive 6mg iv dexamethasone at surgical incision and a repeat dose of 6mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 12mg
n=10 participants at risk
Patients receive 12mg iv dexamethasone at surgical incision and a repeat dose of 12mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Dexamethasone 24mg
n=10 participants at risk
Patients receive 24mg iv dexamethasone at surgical incision and a repeat dose of 24mg of dexamethasone 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Dexamethasone: Intravenous dexamethasone at incision and 24h after incision will be compared in 3 doses and placebo administered in a fourth group
Placebo
n=11 participants at risk
Patients receive a placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision. Pain scores and opioid consumption will be assessed using iv opioid patient controlled analgesia totals. Placebo: Placebo injection of saline at surgical incision and a repeat placebo saline injection 24h after incision.
Renal and urinary disorders
urine retention
0.00%
0/11 • Randomization to 6 month follow up
0.00%
0/10 • Randomization to 6 month follow up
10.0%
1/10 • Number of events 1 • Randomization to 6 month follow up
9.1%
1/11 • Number of events 1 • Randomization to 6 month follow up
Musculoskeletal and connective tissue disorders
fall
0.00%
0/11 • Randomization to 6 month follow up
0.00%
0/10 • Randomization to 6 month follow up
10.0%
1/10 • Number of events 1 • Randomization to 6 month follow up
9.1%
1/11 • Number of events 1 • Randomization to 6 month follow up
Endocrine disorders
hyperglycemia
0.00%
0/11 • Randomization to 6 month follow up
0.00%
0/10 • Randomization to 6 month follow up
20.0%
2/10 • Number of events 2 • Randomization to 6 month follow up
18.2%
2/11 • Number of events 2 • Randomization to 6 month follow up
General disorders
dizziness
0.00%
0/11 • Randomization to 6 month follow up
0.00%
0/10 • Randomization to 6 month follow up
10.0%
1/10 • Number of events 2 • Randomization to 6 month follow up
0.00%
0/11 • Randomization to 6 month follow up
Cardiac disorders
hypotension
9.1%
1/11 • Number of events 1 • Randomization to 6 month follow up
10.0%
1/10 • Number of events 1 • Randomization to 6 month follow up
0.00%
0/10 • Randomization to 6 month follow up
18.2%
2/11 • Number of events 2 • Randomization to 6 month follow up
Injury, poisoning and procedural complications
wound dehisence
0.00%
0/11 • Randomization to 6 month follow up
10.0%
1/10 • Number of events 1 • Randomization to 6 month follow up
0.00%
0/10 • Randomization to 6 month follow up
0.00%
0/11 • Randomization to 6 month follow up

Additional Information

Dr. Stuart Alan Grant

Duke University Health System

Phone: 919-681-6437

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place