Intravenous Dexamethasone Administration in Patients Undergoing Total Shoulder Arthroplasty

The purpose of this study is to detect the efficacy of intravenous perioperative steroid supplementation for total shoulder arthroplasty (TSA) surgeries in terms of short-term and long-term clinical outcomes and to demonstrate its advantages over the routine anaesthesia protocol. The comparison will be evaluated in terms of post- operative pain and function, opioids and analgesic drugs consumption, patient satisfaction, patient reported outcome measures (validated clinical scores), clinician-assessed clinical scores, systemic inflammatory response, length of hospital stay and long-term outcomes. Moreover, to confirm the safety of steroid supplementation all treatment related adverse events- and reactions are going to be recorded and reported, as well as post-operative glycaemia will be monitored.

The primary objective of the study is to show the efficacy on post-operative pain of intravenous perioperative dexamethasone supplementation for TSA.

The secondary objectives of the study are to show superiority by comparison of the intravenous peri- operative dexamethasone supplementation group to the routine analgesia protocol (no steroid supplementation group), in terms of post-operative pain and function, patient satisfaction, shoulder active- and passive range of motion, quantification with validated clinician- and patient reported outcome measures as the Constant, ASES and SSV Scores for function and EQ-5D-3L Score for health-related quality of life, opioids and analgesic drugs consumption, systemic inflammatory response, time until first mobilization and until the patient first slept through at night, the length of hospital stay and presence or absence of a frozen shoulder at the postoperative follow-up, as well as adverse events and reactions, in order to document the advantage over the absence of steroid supplementation in the short-, mid- term- and long-term follow up.

• Post-operative shoulder pain [Time frame: first 3 months after surgery]
• Post-operative shoulder pain [Time frame: 2 and 6 weeks after surgery and 3, 6, 12, 24, 60 ,120 months after surgery]
• Post-operative global shoulder function score [Time frame: daily during the first 3 months]
• Post-operative global shoulder function score [Time frame: 2 and 6 weeks after surgery and 3, 6, 12, 24, 60 ,120 months after surgery]
• The clinician assessed Constant score [Time frame: 2 and 6 weeks after surgery and 3, 6, 12, 24, 60 ,120 months after surgery]
• The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES Score) [Time frame: 2 and 6 weeks after surgery and 3, 6, 12, 24, 60 ,120 months after surgery]
• The Subjective Shoulder Value (SSV) [Time frame: 2 and 6 weeks after surgery and 3, 6, 12, 24, 60 ,120 months after surgery]
• European Quality of Life-5 Dimensions-3 Level [Time frame: 2 and 6 weeks after surgery and 3, 6, 12, 24, 60 ,120 months after surgery]
• PainDETECT [Time frame: 2 and 6 weeks after surgery and 3, 6, 12, 24, 60 ,120 months after surgery]
• Patient satisfaction [Time frame: 2 and 6 weeks after surgery and 3, 6, 12, 24, 60 ,120 months after surgery]
• Post-operative nausea [Time frame: first 3 days post-operative days during hospitalisation]
• Post-operative opioids and analgesic drugs consumption [Time frame: first 3 days post-operative days during hospitalisation]