Purpose
Perioperative glucocorticoids have been effectively used as a pain management regimen
for reducing pain after hand surgery. We hypothesize that a methylprednisolone taper
(MPT) course following surgery will reduce pain and opioid consumption in the early
postoperative period.
Methods
This study was a randomized controlled trial of patients undergoing surgical fixation
for distal radius fracture. Before surgery, patients were randomly assigned to receive
preoperative dexamethasone only or preoperative dexamethasone followed by a 6-day
oral MPT. Patient pain and opioid consumption data were collected for 7 days after
surgery using a patient-reported pain journal.
Results
Our study consisted of 56 patients enrolled from November 2018 to March 2020. Twenty-eight
patients each were assigned to the control and treatment groups. Demographic characteristics
such as age, body mass index, the dominant side affected, smoking status, diabetes
status, and current narcotic use were similar between the control and treatment groups.
With a noticeable, significant reduction starting on postoperative day 2, patients
who received an MPT course consumed substantially less opioids during the first 7
days (7.8 ± 7.2 pills compared with 15.5 ± 11.5 pills, a 50% reduction). These patients
also consumed significantly fewer oral morphine equivalents than the control group
(81.2 vs 41.2). A significant difference in the pain visual analog scale scores between
the 2 groups was noted starting on postoperative day 2, with 48% of the treatment
group reporting no pain by postoperative day 6. No adverse events, including infection
or complications of wound or bone healing, were seen in either group.
Conclusions
There was an early improvement in pain and reduction in early opioid consumption with
a 6-day MPT following surgical fixation for distal radius fracture. With no increased
risk of adverse events in our sample, MPT may be a safe and effective way to reduce
postoperative pain.
Type of study/level of evidence
Therapeutic II.
Key words
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Article info
Publication history
Accepted:
June 7,
2022
Received:
June 6,
2021
Footnotes
Dr Gottschalk receives research support from Stryker Corporation, Konica Minolta, and Arthrex. Dr Daly receives research support from Arthrex. Dr Wagner is a consultant to Stryker Corporation and Wright Medical Group N.V. and receives research support from Arthrex and Konica Minolta.
No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
