The effect of high-dose glucocorticoids on opioid consumption in the first 24 hours after elective hip and knee arthroplasty: A natural experiment study of 47,317 surgeries in Eastern Denmark
- 1Bispebjerg University Hospital
Abstract
BackgroundIn Denmark, high-dose perioperative glucocorticoids were implemented stepwise for patients undergoing total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA). We aimed to estimate the opioid-sparing effect of adding a single high dose of glucocorticoids to the analgesic regimen.
MethodsIn this prespecified analysis of a multicentre natural experiment using electronic health record data, we included all elective THA, TKA, or UKA procedures performed in Eastern Denmark from 2017-2025, with no exclusion criteria. At each centre, procedures before implementation of high-dose glucocorticoids served as controls, whereas procedures after implementation comprised the intervention group. A high dose was defined as [≥]16 mg or 0.2 mg/kg dexamethasone or [≥]80 mg methylprednisolone. The primary outcome was the adjusted between-group difference in 0-24h opioid consumption. The minimal important difference was 5 mg IV morphine equivalents. Secondary outcomes were maximum 0-10 numerical rating scale (NRS) pain score, incidence of opioid-related adverse events, hospital length of stay, and days alive and out of hospital at 30 days.
ResultsWe analysed 47,317 procedures performed at nine centres: 13,010 controls and 34,307 in the intervention group. During the study period, five of nine centres implemented high-dose glucocorticoids for THA patients, two of eight for TKA/UKA patients. High-dose glucocorticoids were administered to 6% and 92% of patients before and after implementation, respectively. The implementation was associated with an adjusted mean reduction of 3.8 mg IV morphine equivalents (95% CI 3.3-4.3) and a 0.8-point lower maximum recorded pain score (99% CI 0.7-0.9) in the first 24 hours, with no statistically significant differences in the remaining outcomes.
ConclusionsImplementation of high-dose glucocorticoids was associated with only a small drop in opioid consumption, below the minimal important difference.
Key Points SummaryO_LIQuestion: What opioid-sparing effects may be expected when adding high-dose glucocorticoids ([≥]16 mg or 0.2 mg/kg dexamethasone or [≥]80 mg methylprednisolone) to the standard analgesic package for patients undergoing total hip and knee arthroplasty? C_LIO_LIFindings: In Eastern Denmark, the adoption of high-dose glucocorticoids to the existing multimodal analgesic regimen was associated with a slightly lower 0-to-24 hours in-hospital opioid consumption, according to electronic health record data. C_LIO_LIMeaning: Clinicians may expect a slightly lower opioid-sparing effect from high-dose glucocorticoids than found in randomised clinical trials. C_LI
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BibTeX
@misc{laigaard2026effect,
title = {{The effect of high-dose glucocorticoids on opioid consumption in the first 24 hours after elective hip and knee arthroplasty: A natural experiment study of 47,317 surgeries in Eastern Denmark}},
author = {J. Laigaard and M. O. Moeller and M. H. Olsen and S. Overgaard and O. Mathiesen and A. P. H. Karlsen},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.31.26361793},
url = {https://www.medrxiv.org/content/10.64898/2026.08.31.26361793v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - The effect of high-dose glucocorticoids on opioid consumption in the first 24 hours after elective hip and knee arthroplasty: A natural experiment study of 47,317 surgeries in Eastern Denmark
AU - J. Laigaard
AU - M. O. Moeller
AU - M. H. Olsen
AU - S. Overgaard
AU - O. Mathiesen
AU - A. P. H. Karlsen
PY - 2026
DA - 2026/08/31
PB - medRxiv
DO - 10.64898/2026.08.31.26361793
UR - https://www.medrxiv.org/content/10.64898/2026.08.31.26361793v1
AB - BackgroundIn Denmark, high-dose perioperative glucocorticoids were implemented stepwise for patients undergoing total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA). We aimed to estimate the opioid-sparing effect of adding a single high dose of glucocorticoids to the analgesic regimen. MethodsIn this prespecified analysis of a multicentre natural experiment using electronic health record data, we included all elective THA, TKA, or UKA procedures performed in Eastern Denmark from 2017-2025, with no exclusion criteria. At each centre, procedures before implementation of high-dose glucocorticoids served as controls, whereas procedures after implementation comprised the intervention group. A high dose was defined as [≥]16 mg or 0.2 mg/kg dexamethasone or [≥]80 mg methylprednisolone. The primary outcome was the adjusted between-group difference in 0-24h opioid consumption. The minimal important difference was 5 mg IV morphine equivalents. Secondary outcomes were maximum 0-10 numerical rating scale (NRS) pain score, incidence of opioid-related adverse events, hospital length of stay, and days alive and out of hospital at 30 days. ResultsWe analysed 47,317 procedures performed at nine centres: 13,010 controls and 34,307 in the intervention group. During the study period, five of nine centres implemented high-dose glucocorticoids for THA patients, two of eight for TKA/UKA patients. High-dose glucocorticoids were administered to 6% and 92% of patients before and after implementation, respectively. The implementation was associated with an adjusted mean reduction of 3.8 mg IV morphine equivalents (95% CI 3.3-4.3) and a 0.8-point lower maximum recorded pain score (99% CI 0.7-0.9) in the first 24 hours, with no statistically significant differences in the remaining outcomes. ConclusionsImplementation of high-dose glucocorticoids was associated with only a small drop in opioid consumption, below the minimal important difference. Key Points SummaryO_LIQuestion: What opioid-sparing effects may be expected when adding high-dose glucocorticoids ([≥]16 mg or 0.2 mg/kg dexamethasone or [≥]80 mg methylprednisolone) to the standard analgesic package for patients undergoing total hip and knee arthroplasty? C_LIO_LIFindings: In Eastern Denmark, the adoption of high-dose glucocorticoids to the existing multimodal analgesic regimen was associated with a slightly lower 0-to-24 hours in-hospital opioid consumption, according to electronic health record data. C_LIO_LIMeaning: Clinicians may expect a slightly lower opioid-sparing effect from high-dose glucocorticoids than found in randomised clinical trials. C_LI
ER -