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Meta-Analysis
. 2017 Nov;96(47):e8804.
doi: 10.1097/MD.0000000000008804.

Preoperative intravenous glucocorticoids can decrease acute pain and postoperative nausea and vomiting after total hip arthroplasty: A PRISMA-compliant meta-analysis

Qing Yang  1 , Zhi Zhang, Wenqi Xin, Aixiang Li
Affiliations
Meta-Analysis

Preoperative intravenous glucocorticoids can decrease acute pain and postoperative nausea and vomiting after total hip arthroplasty: A PRISMA-compliant meta-analysis

Qing Yang et al. Medicine (Baltimore). 2017 Nov.

Erratum in

Abstract

Background: A systematic review and meta-analysis of published randomized controlled trials (RCTs) were performed to assess the efficacy and safety of preoperative intravenous glucocorticoids versus controls for the prevention of postoperative acute pain and postoperative nausea and vomiting (PONV) after primary total hip arthroplasty (THA).

Methods: A computer literature search of electronic databases, including PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), and China Wanfang database, was conducted to identify the relevant RCTs comparing preoperative intravenous glucocorticoids versus placebos for reducing acute pain and PONV in THA patients. The primary outcomes included the use of the visual analog scale (VAS) with rest or mobilization at 6, 24, 48, and 72 hours and the occurrence of PONV. The secondary outcome was total morphine consumption. We calculated the risk ratio (RR) with a 95% confidence interval (95% CI) for dichotomous outcomes, and the weighted mean difference (WMD) with a 95% CI for continuous outcomes.

Results: Pooled data from 7 RCTs (411 THAs) favored preoperative intravenous glucocorticoids against acute pain intensity at 4, 24, and 48 hours (P < .05). There was no significant difference between the VAS with rest or mobilization at 72 hours (P > .05). Subsequently, preoperative intravenous glucocorticoids provided a total morphine-sparing effect of 9.36 mg (WMD = -9.36, 95% CI = -12.33 to -6.38, P = .000). In addition, preoperative intravenous glucocorticoids were associated with a significant reduction of the occurrence of PONV (RR = 0.41, 95% CI = 0.30-0.57, P = .000).

Conclusion: Intravenous glucocorticoids can decrease early pain intensity and PONV after THA. However, the low number of studies and variation in dosing regimens limits the evidence for its use. Thus, more high-quality RCTs are still needed to identify the optimal drug and the safety of intravenous glucocorticoids.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Study selection flowchart.
Figure 2
Figure 2
(A) The risk of bias graph; (B) The risk of bias summary; “+” represents a low risk of bias, “?” represents an unclear risk of bias; and “-” represents a high risk of bias.
Figure 3
Figure 3
Forest plots of the included studies comparing the VAS with rest at 6, 24, 48, and 72 hours.
Figure 4
Figure 4
Forest plots of the included studies comparing the VAS with mobilization at 6, 24, 48, and 72 hours.
Figure 5
Figure 5
Forest plots of the included studies comparing the occurrence of PONV.
Figure 6
Figure 6
Scatter plot showing the relationship between the changing of glucocorticoid dose and the occurrence of PONV.
Figure 7
Figure 7
Meta-regression of the dose and the occurrence of PONV.
Figure 8
Figure 8
Forest plots of the included studies comparing the total morphine consumption.
Figure 9
Figure 9
Begg test of the VAS with rest at 6, 24, 48, and 72 hours.
See this image and copyright information in PMC

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