Preoperative intravenous glucocorticoids can reduce postoperative acute pain following total knee arthroplasty: A meta-analysis

Abstract

Background: The ability of preoperative intravenous glucocorticoids to control pain after total knee arthroplasty (TKA) has been examined in many studies, but it remains controversial. Therefore, we undertook a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of preoperative intravenous glucocorticoids for postoperative pain management after TKA.

Methods: We systematically searched RCTs from electronic databases, including PubMed, Embase, Web of Science, the Cochrane Library, the Chinese Wanfang Database, and the China National Knowledge Infrastructure database. The outcomes included visual analogue scale (VAS) scores at 6, 12, 24, 48, and 72 hours after TKA; the occurrence of postoperative nausea and vomiting (PONV); blood glucose at 6 and 24 hours after TKA; and the occurrence of infection.

Results: Of the identified studies, a total of 11 RCTs involving 1000 patients (glucocorticoids = 501, control = 499) were included in this meta-analysis. Compared with a placebo, preoperative intravenous glucocorticoids significantly reduced VAS scores at 6, 12, 24, and 48 hours, with decreases of 3.63 points, 6.81 points, 10.40 points, and 3.15 points, respectively, on a 110-point VAS. Moreover, intravenous glucocorticoids were associated with significant decreases of 19.4% and 16.8% in the occurrence of nausea and vomiting, respectively. However, intravenous glucocorticoids were also associated with increased blood glucose with no clinical importance at 6 hours after TKA. No significant difference was found in the occurrence of infection or in blood glucose at 24 hours after TKA.

Conclusion: Preoperative intravenous glucocorticoids are an effective and safe method to reduce postoperative pain and PONV in patients following TKA. More studies are necessary to identify the optimal dose and type of glucocorticoids for maximal pain control.

Figure 1

Study selection flowchart.

Figure 2

Summary of the risk of bias.

Figure 3

Graph of the risk of bias.

Figure 4

Forest plot comparing VAS at 6, 12, 24, 48, and 72 hours after TKA between the glucocorticoid group and the control group.

Figure 5

Scatterplot comparing the dose of glucocorticoids with the VAS at (A) 6 hours, (B) 12 hours, (C) 24 hours, and (D) 72 hours.

Figure 6

Forest plot comparing total morphine consumption at 24 and 48 hours between the glucocorticoid group and the control group.

Figure 7

Forest plot comparing the occurrence of postoperative nausea and vomiting between glucocorticoids group and control group.

Figure 8

Scatterplot comparing glucocorticoids dose with the incidence of nausea.

Figure 9

Scatterplot comparing glucocorticoids dose with the incidence of vomiting.

Figure 10

Forest plot comparing the occurrence of postoperative pruritus between glucocorticoids group and control group.

Figure 11

Forest plot comparing the incidence of infection between the between glucocorticoids group and control group.

Figure 12

Forest plot comparing the blood glucose between the glucocorticoids group and control group.