human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND High-dose glucocorticoid may reduce postsurgical pain  and improve recovery . We hypothesized that 125 mg methylprednisolone ( MP ) would reduce time to meet functional discharge criteria after total hip arthroplasty ( THA ) . METHODS Forty-eight patients undergoing unilateral THA under spinal anaesthesia were consecutively included in this r and omized , double-blind , placebo-controlled trial receiving preoperative i.v . MP or saline . All patients received a st and ardized , multimodal analgesic regime with paracetamol , celecoxib , and gabapentin . The primary outcome was time to meet well-defined functional discharge criteria . Secondary outcomes were h and grip strength and endurance , pain , nausea , vomiting , fatigue , sleep quality , and rescue analgesic- , antiemetic- , and hypnotic medicine requirements . The inflammatory response measured by C-reactive protein ( CRP ) and actual length of stay were also registered . Discharge criteria were assessed twice daily ( at 09:00 and 14:00 h ) until discharge . Other outcomes were assessed at 2 , 4 , 6 , 8 , and 24 h after operation , and also in a question naire from postoperative day ( POD ) 1 - 4 . RESULTS Time to meet discharge criteria was [ median ( IQR ) ( 95 % CI ) , MP vs placebo ] : 23.5 ( 23.3 - 23.7 ) ( 17.8 - 43.8 ) vs 23.5 ( 23.0 - 23.8 ) ( 20.0 - 46.8 ) h , the mean difference ( 95 % CI ) being -1.3 ( -4.7 to 2.2 ) h , P=0.65 . Overall pain for the first 24 h after surgery was significantly reduced in the MP vs the placebo group ( P<0.01 ) , as was CRP at 24 h ( P<0.0001 ) . No other between-group differences were observed . No drug-related complications were observed at follow-up on POD30 . CONCLUSIONS MP 125 mg i.v . before surgery added to a multimodal oral analgesic regime did not reduce time to meet functional discharge criteria after THA , but improved analgesia for the first 24 Abstract Current trends in orthopaedic surgery have explored different forms of adjuvant treatments to minimize postoperative pain and the risk of nausea and vomiting . A small single preoperative dose of dexamethasone , as part of a comprehensive multimodal analgesic regimen in low-risk patients undergoing total hip arthroplasty ( THA ) , provides antiemetic and opioid-sparing effects but the longer-term effects on pain , complications , or function are not known . We therefore asked whether such a routine would affect longer-term pain , complications , or function . Fifty patients undergoing elective primary THA using spinal anesthesia were initially r and omized to receive either dexamethasone ( 40 mg intravenous ) or saline placebo . The patients , anesthesiologists , nurses , and research coordinators were blinded to the study arms . The functional outcome was measured using the Harris hip score . Outcomes were assessed 6 weeks and 1 year postoperatively . We observed no difference in resting pain between the two groups at either time period . Both groups had similar functional outcome scores for the total Harris hip score and individual scoring items at each followup interval . There were no wound complications , deep infections , or osteonecrosis in the contralateral hip at 1-year followup . We recommend the addition of a small single preoperative dose of dexamethasone to a comprehensive multimodal analgesic regimen in low-risk patients given its immediate antiemetic and opioid-sparing effects , and absence of subsequent effects . Level of Evidence : Level II , therapeutic study ( prospect i ve comparative study ) . See the Guidelines for Authors for a complete description of levels of evidence Background Dexamethasone is a potent analgesic and antiemetic . However , the benefit of dexamethasone after TKA is unclear , as is the efficacy in a current multimodal regime . Questions / purpose sWe determined ( 1 ) whether the addition of dexamethasone to a protocol including ramosetron further reduces postoperative emesis compared with ramosetron alone ; ( 2 ) whether it reduces postoperative pain ; and ( 3 ) whether it increases the risk for wound complications in a current multimodal regime after TKA . Methods We r and omized 269 patients undergoing TKAs to receive dexamethasone ( 10 mg ) 1 hour before surgery and ramosetron  immediately after surgery ( Dexa-Ra  group , n = 135 ) , or  ramosetron alone ( Ra group , n = 134 ) . We recorded the incidence of postoperative nausea and vomiting ( PONV ) , severity of nausea , incidence of antiemetic requirement , complete response , pain level , and opioid consumption . Patients were assessed 0 to 6 , 6 to 24 , 24 to 48 , and 48 to 72 hours postoperatively . In addition , patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery . Results The Dexa-Ra group had a lower incidence of PONV during the entire 72-hour evaluation period and experienced less severe nausea for the first 6 hours after TKA , although not between 6 to 72 hours . Overall use of a rescue antiemetic was less frequent , and complete response was more frequent in the Dexa-Ra group . Patients in the Dexa-Ra group experienced lower pain and consumed less opioids during the 6- to 24-hour period and during the overall study period . No differences were found in wound complications between the groups , and each group had one case of periprosthetic joint infection . Conclusions Patients who received prophylactic dexamethasone in addition to ramosetron had reduced postoperative emesis and pain without increased risks for wound complications , compared with patients who received ramosetron alone in patients managed using a multimodal regimen after TKA.Level of Evidence Level I , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more UNLABELLED This double-blind , r and omized , placebo-controlled study evaluated the minimum effective dose of dexamethasone for postoperative antiemesis .  One-hundred fifty women scheduled for major gynecological surgery were r and omly assigned to receive dexamethasone 10 mg ( D10 ) , 5 mg ( D5 ) , 2.5 mg ( D2.5 ) , 1.25 mg ( D1.25 ) , or placebo ( P ) before the induction of general anesthesia . A st and ardized general anesthesia technique was used . Postoperative pain was treated with bolus IV doses of morphine via a patient-controlled analgesia device . Patients were assessed for incidence of vomiting at 4 , 8 , 12 , and 24 h after surgery . A total of 6 , 6 , 8 , 15 , and 19 patients in Groups D10 , D5 , D2.5 , D1.25 , and Group P experienced vomiting at least once within the first postoperative 24 h , respectively . Dexamethasone 10 mg , 5 mg , and 2.5 mg was more effective than dexamethasone 1.25 mg or placebo for antiemesis ( P < 0.05 ) . The difference in antiemetic effect among the 10 mg , 5 mg , and 2.5 mg groups was similar . The results suggest that 2.5 mg is the minimum effective dose of dexamethasone for postoperative antiemesis in patients undergoing general anesthesia for major gynecological surgery . IMPLICATION S Although dexamethasone is effective for antiemesis , major side effects may accompany its perioperative use . To achieve the best antiemesis with the fewest side effects , dexamethasone 10 mg , 5 mg , 2.5 mg , and 1.25 mg were compared with placebo in surgical patients . We found 2.5 mg to be the minimum effective dose without discernible side effects BACKGROUND Total knee arthroplasty ( TKA ) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach , but the effect of high-dose glucocorticoid administration has not been studied . METHODS Forty-eight patients undergoing unilateral TKA were included in a r and omized , double-blind , placebo-controlled trial receiving preoperative methylprednisolone ( MP ) 125 mg i.v . or saline . All surgery was performed under lumbar spinal anaesthesia and patients received a st and ardized , multimodal analgesic regime . The primary endpoint was pain during walking 24 h after surgery , and secondary endpoints were pain at rest , pain upon hip flexion , and pain upon knee flexion . Pain assessment s were performed repeatedly for the first 48 h after surgery , in a question naire from days 2 to 10 , and at follow-up on days 21 and 30 . Tertiary endpoints were postoperative nausea and vomiting ( PONV ) , plasma C-reactive protein ( CRP ) concentrations , fatigue , sleep quality , and rescue analgesic and antiemetic requirements . RESULTS Pain during walking was significantly lower in the MP group up to 32 h after operation . Overall pain and cumulative pain scores ( 2 - 48 h ) were lower for all pain assessment s ( P<0.04 ) . Consumption of rescue oxycodone  was lower from 0 to 24 h ( P=0.02 ) and PONV , consumption of ondansetron  reduced ( P<0.05 ) , and CRP concentrations were lower at 24 h ( P<0.000001 ) . Fatigue throughout the day of surgery was lower ( P=0.02 ) , but sleep quality was worse on the first night ( P=0.002 ) . No side-effects or complications were observed in other respects . CONCLUSIONS MP 125 mg before surgery improves analgesia and immediate recovery after TKA , even when combined with a multimodal analgesic regime . These findings call for further studies on safety aspects Background : In previous studies on glucocorticoids for  postoperative pain  , the test drug has been given perioperatively , usually before measurement of baseline pain . In order to evaluate the time course and magnitude of the analgesic effect of a glucocorticoid in well‐established postoperative pain , we compared methylprednisolone with ketorolac and placebo , after assessment of baseline pain on the first postoperative day BACKGROUND : Preoperative glucocorticoids reduce postoperative nausea but may also improve analgesia and decrease opioid consumption . METHODS : Fifty consecutive patients undergoing elective , unilateral , primary total hip arthroplasty under spinal anesthesia with propofol sedation received in a r and omized , double-blind , placebo-controlled manner either 40 mg of dexamethasone or saline placebo IV before the start of surgery . IV patient-controlled analgesia morphine , ibuprofen 400 mg po q6 h and acetaminophen 650 mg po q6 h were given for 48 h. Pain ( 0–10 numeric rating scale , NRS ) at rest , side effects , and total cumulative patient-controlled analgesia morphine consumption were recorded q4 h for 48 h. Dynamic pain NRS score was recorded at 24 h. C-reactive protein levels were measured in a subgroup of 25 patients at 48 h. RESULTS : The intraoperative sedation requirement with propofol was significantly increased in the dexamethasone group ( 234.6 ± 160.1 vs 138.8 ± 122.7 mg , P = 0.02 ) . Dynamic pain was greatly reduced in the dexamethasone group ( NRS score : 2.7 , 95 % CI : 2.2–3.1 vs 6.8 , 6.4–7.2 ; P < 0.0001 ) . There was no significant effect on pain at rest or cumulative morphine consumption at any time . C-reactive protein levels at 48 h were markedly reduced by dexamethasone ( 52.4 mg/mL , 28.2–76.6 vs 194.2 , 168.9–219.4 ; P < 0.0001 ) . Seven patients in the control group , but only one in the dexamethasone group , were treated for nausea ( P = 0.05 ) . CONCLUSIONS : A single , preoperative IV dose of dexamethasone 40 mg has a prolonged suppressive effect on the inflammatory response and decreases dynamic pain 24 h after total hip arthroplasty Controlling postoperative pain and nausea after total joint arthroplasty remains an important challenge . We conducted a prospect i ve , r and omized controlled trial with 120 patients to determine if the addition of perioperative dexamethasone to a multimodal regimen improves antiemetic and analgesic control , enhances mobility 
    Output:
    
agent
Meta- analysis showed that high-dose systemic steroid ( dexamethasone > 0.1 mg/kg ) rather than low dose is effective to reduce postoperative nausea and vomiting and postoperative acute pain ( within 24 h ) .
In addition , systemic steroid is associated within faster functional rehabilitation and greater inflammation control .
On the other h and , systemic steroid is associated with a higher level of postoperative serum glucose on the operation day .
Conclusions Our study suggests that by providing lower incidence of postoperative nausea and vomiting and less postoperative acute pain , high-dose systemic steroid plays a critical role in rapid recovery to TKA and THA .
The preliminary results also show the superior possibility of systemic steroid in functional rehabilitation and inflammation control .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND High-dose glucocorticoid may reduce postsurgical pain  and improve recovery . We hypothesized that 125 mg methylprednisolone ( MP ) would reduce time to meet functional discharge criteria after total hip arthroplasty ( THA ) . METHODS Forty-eight patients undergoing unilateral THA under spinal anaesthesia were consecutively included in this r and omized , double-blind , placebo-controlled trial receiving preoperative i.v . MP or saline . All patients received a st and ardized , multimodal analgesic regime with paracetamol , celecoxib , and gabapentin . The primary outcome was time to meet well-defined functional discharge criteria . Secondary outcomes were h and grip strength and endurance , pain , nausea , vomiting , fatigue , sleep quality , and rescue analgesic- , antiemetic- , and hypnotic medicine requirements . The inflammatory response measured by C-reactive protein ( CRP ) and actual length of stay were also registered . Discharge criteria were assessed twice daily ( at 09:00 and 14:00 h ) until discharge . Other outcomes were assessed at 2 , 4 , 6 , 8 , and 24 h after operation , and also in a question naire from postoperative day ( POD ) 1 - 4 . RESULTS Time to meet discharge criteria was [ median ( IQR ) ( 95 % CI ) , MP vs placebo ] : 23.5 ( 23.3 - 23.7 ) ( 17.8 - 43.8 ) vs 23.5 ( 23.0 - 23.8 ) ( 20.0 - 46.8 ) h , the mean difference ( 95 % CI ) being -1.3 ( -4.7 to 2.2 ) h , P=0.65 . Overall pain for the first 24 h after surgery was significantly reduced in the MP vs the placebo group ( P<0.01 ) , as was CRP at 24 h ( P<0.0001 ) . No other between-group differences were observed . No drug-related complications were observed at follow-up on POD30 . CONCLUSIONS MP 125 mg i.v . before surgery added to a multimodal oral analgesic regime did not reduce time to meet functional discharge criteria after THA , but improved analgesia for the first 24 Abstract Current trends in orthopaedic surgery have explored different forms of adjuvant treatments to minimize postoperative pain and the risk of nausea and vomiting . A small single preoperative dose of dexamethasone , as part of a comprehensive multimodal analgesic regimen in low-risk patients undergoing total hip arthroplasty ( THA ) , provides antiemetic and opioid-sparing effects but the longer-term effects on pain , complications , or function are not known . We therefore asked whether such a routine would affect longer-term pain , complications , or function . Fifty patients undergoing elective primary THA using spinal anesthesia were initially r and omized to receive either dexamethasone ( 40 mg intravenous ) or saline placebo . The patients , anesthesiologists , nurses , and research coordinators were blinded to the study arms . The functional outcome was measured using the Harris hip score . Outcomes were assessed 6 weeks and 1 year postoperatively . We observed no difference in resting pain between the two groups at either time period . Both groups had similar functional outcome scores for the total Harris hip score and individual scoring items at each followup interval . There were no wound complications , deep infections , or osteonecrosis in the contralateral hip at 1-year followup . We recommend the addition of a small single preoperative dose of dexamethasone to a comprehensive multimodal analgesic regimen in low-risk patients given its immediate antiemetic and opioid-sparing effects , and absence of subsequent effects . Level of Evidence : Level II , therapeutic study ( prospect i ve comparative study ) . See the Guidelines for Authors for a complete description of levels of evidence Background Dexamethasone is a potent analgesic and antiemetic . However , the benefit of dexamethasone after TKA is unclear , as is the efficacy in a current multimodal regime . Questions / purpose sWe determined ( 1 ) whether the addition of dexamethasone to a protocol including ramosetron further reduces postoperative emesis compared with ramosetron alone ; ( 2 ) whether it reduces postoperative pain ; and ( 3 ) whether it increases the risk for wound complications in a current multimodal regime after TKA . Methods We r and omized 269 patients undergoing TKAs to receive dexamethasone ( 10 mg ) 1 hour before surgery and ramosetron  immediately after surgery ( Dexa-Ra  group , n = 135 ) , or  ramosetron alone ( Ra group , n = 134 ) . We recorded the incidence of postoperative nausea and vomiting ( PONV ) , severity of nausea , incidence of antiemetic requirement , complete response , pain level , and opioid consumption . Patients were assessed 0 to 6 , 6 to 24 , 24 to 48 , and 48 to 72 hours postoperatively . In addition , patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery . Results The Dexa-Ra group had a lower incidence of PONV during the entire 72-hour evaluation period and experienced less severe nausea for the first 6 hours after TKA , although not between 6 to 72 hours . Overall use of a rescue antiemetic was less frequent , and complete response was more frequent in the Dexa-Ra group . Patients in the Dexa-Ra group experienced lower pain and consumed less opioids during the 6- to 24-hour period and during the overall study period . No differences were found in wound complications between the groups , and each group had one case of periprosthetic joint infection . Conclusions Patients who received prophylactic dexamethasone in addition to ramosetron had reduced postoperative emesis and pain without increased risks for wound complications , compared with patients who received ramosetron alone in patients managed using a multimodal regimen after TKA.Level of Evidence Level I , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more UNLABELLED This double-blind , r and omized , placebo-controlled study evaluated the minimum effective dose of dexamethasone for postoperative antiemesis .  One-hundred fifty women scheduled for major gynecological surgery were r and omly assigned to receive dexamethasone 10 mg ( D10 ) , 5 mg ( D5 ) , 2.5 mg ( D2.5 ) , 1.25 mg ( D1.25 ) , or placebo ( P ) before the induction of general anesthesia . A st and ardized general anesthesia technique was used . Postoperative pain was treated with bolus IV doses of morphine via a patient-controlled analgesia device . Patients were assessed for incidence of vomiting at 4 , 8 , 12 , and 24 h after surgery . A total of 6 , 6 , 8 , 15 , and 19 patients in Groups D10 , D5 , D2.5 , D1.25 , and Group P experienced vomiting at least once within the first postoperative 24 h , respectively . Dexamethasone 10 mg , 5 mg , and 2.5 mg was more effective than dexamethasone 1.25 mg or placebo for antiemesis ( P < 0.05 ) . The difference in antiemetic effect among the 10 mg , 5 mg , and 2.5 mg groups was similar . The results suggest that 2.5 mg is the minimum effective dose of dexamethasone for postoperative antiemesis in patients undergoing general anesthesia for major gynecological surgery . IMPLICATION S Although dexamethasone is effective for antiemesis , major side effects may accompany its perioperative use . To achieve the best antiemesis with the fewest side effects , dexamethasone 10 mg , 5 mg , 2.5 mg , and 1.25 mg were compared with placebo in surgical patients . We found 2.5 mg to be the minimum effective dose without discernible side effects BACKGROUND Total knee arthroplasty ( TKA ) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach , but the effect of high-dose glucocorticoid administration has not been studied . METHODS Forty-eight patients undergoing unilateral TKA were included in a r and omized , double-blind , placebo-controlled trial receiving preoperative methylprednisolone ( MP ) 125 mg i.v . or saline . All surgery was performed under lumbar spinal anaesthesia and patients received a st and ardized , multimodal analgesic regime . The primary endpoint was pain during walking 24 h after surgery , and secondary endpoints were pain at rest , pain upon hip flexion , and pain upon knee flexion . Pain assessment s were performed repeatedly for the first 48 h after surgery , in a question naire from days 2 to 10 , and at follow-up on days 21 and 30 . Tertiary endpoints were postoperative nausea and vomiting ( PONV ) , plasma C-reactive protein ( CRP ) concentrations , fatigue , sleep quality , and rescue analgesic and antiemetic requirements . RESULTS Pain during walking was significantly lower in the MP group up to 32 h after operation . Overall pain and cumulative pain scores ( 2 - 48 h ) were lower for all pain assessment s ( P<0.04 ) . Consumption of rescue oxycodone  was lower from 0 to 24 h ( P=0.02 ) and PONV , consumption of ondansetron  reduced ( P<0.05 ) , and CRP concentrations were lower at 24 h ( P<0.000001 ) . Fatigue throughout the day of surgery was lower ( P=0.02 ) , but sleep quality was worse on the first night ( P=0.002 ) . No side-effects or complications were observed in other respects . CONCLUSIONS MP 125 mg before surgery improves analgesia and immediate recovery after TKA , even when combined with a multimodal analgesic regime . These findings call for further studies on safety aspects Background : In previous studies on glucocorticoids for  postoperative pain  , the test drug has been given perioperatively , usually before measurement of baseline pain . In order to evaluate the time course and magnitude of the analgesic effect of a glucocorticoid in well‐established postoperative pain , we compared methylprednisolone with ketorolac and placebo , after assessment of baseline pain on the first postoperative day BACKGROUND : Preoperative glucocorticoids reduce postoperative nausea but may also improve analgesia and decrease opioid consumption . METHODS : Fifty consecutive patients undergoing elective , unilateral , primary total hip arthroplasty under spinal anesthesia with propofol sedation received in a r and omized , double-blind , placebo-controlled manner either 40 mg of dexamethasone or saline placebo IV before the start of surgery . IV patient-controlled analgesia morphine , ibuprofen 400 mg po q6 h and acetaminophen 650 mg po q6 h were given for 48 h. Pain ( 0–10 numeric rating scale , NRS ) at rest , side effects , and total cumulative patient-controlled analgesia morphine consumption were recorded q4 h for 48 h. Dynamic pain NRS score was recorded at 24 h. C-reactive protein levels were measured in a subgroup of 25 patients at 48 h. RESULTS : The intraoperative sedation requirement with propofol was significantly increased in the dexamethasone group ( 234.6 ± 160.1 vs 138.8 ± 122.7 mg , P = 0.02 ) . Dynamic pain was greatly reduced in the dexamethasone group ( NRS score : 2.7 , 95 % CI : 2.2–3.1 vs 6.8 , 6.4–7.2 ; P < 0.0001 ) . There was no significant effect on pain at rest or cumulative morphine consumption at any time . C-reactive protein levels at 48 h were markedly reduced by dexamethasone ( 52.4 mg/mL , 28.2–76.6 vs 194.2 , 168.9–219.4 ; P < 0.0001 ) . Seven patients in the control group , but only one in the dexamethasone group , were treated for nausea ( P = 0.05 ) . CONCLUSIONS : A single , preoperative IV dose of dexamethasone 40 mg has a prolonged suppressive effect on the inflammatory response and decreases dynamic pain 24 h after total hip arthroplasty Controlling postoperative pain and nausea after total joint arthroplasty remains an important challenge . We conducted a prospect i ve , r and omized controlled trial with 120 patients to determine if the addition of perioperative dexamethasone to a multimodal regimen improves antiemetic and analgesic control , enhances mobility 
    Output:
    