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· DOS Abstracts
Effect of preoperative methylprednisolone on ortho-
static hypotension during early mobilization after total
hip arthroplasty - a randomized, double-blind, place-
bo-controlled trial
Viktoria Lindberg-Larsen, Pelle Petersen, Øivind Jans, Torben Beck, Henrik Kehlet
Section for Surgical Pathophysiology, Rigshospitalet; Section for Surgical Patho-
physiology, Rigshospitalet; The Lundbeck Foundation Centre for Fast-Track Hip
and Knee Arthroplasty, The Lundbeck Foundation Centre for Fast-Track Hip
and Knee Arthroplasty; Department of Orthopaedic Surgery, Bispebjerg and
Frederiksberg Hospital; Section for Surgical Pathophysiology, Rigshospitalet
Background:
Orthostatic hypotension (OH) and intolerance (OI) are common
after total hip arthroplasty (THA) and may delay early mobilization as well as
increase the risk of fainting and falling. The pathology of OH and OI includes
a dysregulated postoperative vasopressor response, by a hitherto unknown
mechanism.
Purpose / Aim of Study:
We hypothesized that OH and OI could potentially
be related to the inflammatory stress response which is inhibited by steroid ad-
ministration. Consequently, this study evaluated the effect of a preoperative
high- dose methylprednisolone on OH and OI early after THA.
Materials and Methods:
A randomized, double-blind, placebo-controlled
study in 59 patients undergoing elective unilateral THA with spinal anesthesia
and a standardized multimodal analgesic regime. Patients were allocated (1:1)
to preoperative intravenous (IV) methylprednisolone (MP) 125 mg or isotonic
saline (C). OH, OI and cardiovascular responses were evaluated using a stan-
dardized mobilization protocol preoperatively, 6, and 24 hours after surgery.
Systolic (SAP) and diastolic (DAP) arterial pressure and heart rate (HR) were
measured non-invasively (Nexfin®). The systemic inflammation was monitored
by C- reactive protein (CRP).
Findings / Results:
At 6 hours postoperatively, 11 (38%) versus 11 (37%)
patients had OH in group MP and group C, respectively (RR 0.97 (0.58 to
1.64; p=0.92)), whereas OI was present in 9 (31%) versus 13 (43%) patients
(RR 1.29 (0.79 to 2.11; p=0.33)), respectively. At 24 hours postoperative-
ly, the prevalence of OH and OI did not differ between groups (p=0.24 and
p=0.11, respectively), though CRP levels were significantly reduced in group
MP (p<0.001).
Conclusions:
Preoperative administration of 125 mg methylprednisolone did
not reduce the prevalence of OH or OI compared with placebo despite a reduced
systemic inflammatory response.
No conflicts of interest reported
68.