Research Summary

Does Intravenous Dexamethasone Reduce Postoperative Pain After Total Knee Arthroplasty?

Anthony Calabro, MA

Key Highlights

  • Intravenous dexamethasone significantly reduces 24-hour postoperative pain scores following TKA compared to placebo.
  • A single dose of 8-10 mg administered preoperatively or at induction appears sufficient for analgesic benefit.
  • Pain reduction was consistent across spinal, epidural, and general anesthesia types.
  • Repeat doses did not confer additional analgesic benefits compared to single-dose administration.

Intravenous (IV) dexamethasone was associated with statistically and clinically significant reductions in 24-hour postoperative pain scores in adults undergoing anesthesia for total knee arthroplasty (TKA),1 according to the results of a study presented at the American Association of Nurse Anesthesiology (AANA) 2025 Annual Congress. Patients who received IV dexamethasone reported lower visual analog scale (VAS) scores than those who received placebo.

The authors of the study, Bailey Coons, BSN, RN, CCRN and Dru Riddle, PhD, DNP, CRNA, FAAN, noted that there is a clinical need to address postoperative pain in patients who underwent TKA, a population known to experience high levels of discomfort after surgery. Although dexamethasone is commonly used for prophylaxis against postoperative nausea and vomiting, its role in pain control remains underused due to uncertainty regarding its analgesic dosing, timing, and adverse effect profile.

The authors conducted a literature search using PubMed, Medline Ultimate, and CINAHL Ultimate, applying terms such as "dexamethasone," "postoperative pain," and "total knee arthroplasty." Inclusion criteria limited results to English-language studies in adults aged 19 years and older. Of 117 studies identified, one systematic review and meta-analysis and two RCTs met the criteria, encompassing a total sample of 2314 patients. The primary outcome was postoperative pain scores 24 hours after surgery.

All three studies demonstrated a statistically significant reduction in 24-hour postoperative VAS pain scores among patients who received IV dexamethasone. Doses ranged from 8 to 24 mg, administered either as a single preoperative dose or in repeated doses pre- and postoperatively. Timing of administration varied from 1 hour before to 48 hours after surgery. Liang et al.2 and Gasbjerg et al.3 found no significant differences between single-dose and repeat dosing regimens. Khan et al.4 individualized dexamethasone dosing by patient weight (0.1 mg/kg) but still observed significant pain reduction. Most studies recommended an 8-10 mg dose for effective analgesia.

Limitations included small sample sizes, variability in dosing regimens, high heterogeneity in study design, and lack of long-term follow-up on adverse effects. In addition, differing pain scale ranges and perioperative analgesic protocols further limited generalizability.

“IV dexamethasone reduces postoperative pain scores in adults undergoing anesthesia for TKA and should be considered as an adjunct for multimodal analgesic regimens,” the authors concluded.

References

  1. Coons B, Riddle D. Intravenous dexamethasone and postoperative pain scores in total knee arthroplasty. Poster presented at: AANA Annual Congress; 2025 Aug; Nashville, TN.
  2. Liang S, Xing M, Jiang S, Zou W. Effect of intravenous dexamethasone on postoperative pain in patients undergoing total knee arthroplasty: a systematic review and meta-analysis. Pain Physician. 2022;25(2):E169-E183.
  3. Gasbjerg KS, Hägi-Pedersen D, Lunn TH, et al. Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial. BMJ. 2022;376:e067325. Published 2022 Jan 4. doi:10.1136/bmj-2021-067325
  4. Khan J, Ashraf RA, Bilal Shabbir HM, et al. The effect of dexamethasone on postoperative pain management in patients undergoing total knee arthroplasty: a randomized controlled trial. Cureus. 2023;15(4):e37052. Published 2023 Apr 3. doi:10.7759/cureus.37052