The role of perioperative intravenous low-dose dexamethasone in rapid recovery after total knee arthroplasty: a meta-analysis

Abstract

Purpose: The purpose of this meta-analysis was to evaluate the overall safety and effectiveness of perioperative intravenous dexamethasone to facilitate postoperative rehabilitation in patients after total knee arthroplasty (TKA).

Methods: A comprehensive literature search was performed using the Embase, PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases for relevant randomized controlled trials (RCTs) from inception to 2020. Methodological quality of the trials was assessed using the Cochrane Risk of Bias Tool, and the relevant data were extracted using a predefined data extraction form.

Results: Ten RCTs with 1100 knees were included. Our study showed a significant reduction in pain using a postoperative pain visual analog scale (VAS) at 24 hours and 48 hours, total opioid consumption at 24 hours and 48 hours, postoperative nausea and vomiting (PONV), active range of motion (ROM) limitation, and passive ROM limitation at 72 hours in dexamethasone-treated groups compared with controls.

Conclusion: Intravenous low-dose dexamethasone is potentially useful in the perioperative setting for reducing postsurgical immediate ROM limitations, pain, opioid consumption, and PONV. There are no data that directly attribute an increase in postoperative complications to intravenous dexamethasone. More high-quality studies are necessary to draw these conclusions.

Keywords: Intravenous dexamethasone; low-dose; meta-analysis; opioid consumption; pain; postoperative nausea and vomiting; range of motion; rapid recovery; total knee arthroplasty.

Figure 1.

Flow diagram of the literature search. THA, total hip arthroplasty.

Figure 2.

Risk of bias summary for the included studies. (+ represents yes; – represents no; ? represents unclear).

Figure 3.

Forest plot for the comparison of VAS at 24 hours and 48 hours after surgery. VAS, visual analog scale.

Figure 4.

Forest plot for the comparison of ROM at 72 hours after surgery among the two subgroups. ROM, range of motion.

Figure 5.

Forest plot for the comparison of PONV. PONV, postoperative nausea and vomiting.

Figure 6.

Forest plot for the comparison of complications.

Figure 7.

Forest plot for the comparison of total opioid consumption at 24 hours and 48 hours after surgery.

Figure 8.

Forest plot for the comparison of LOS. LOS, length of stay.

Figure 9.

Forest plot for the comparison of blood glucose at 24 hours and 72 hours after surgery.

Figure 10.

Begg’s funnel plot of the current meta-analysis of VAS at 24 hours after surgery. VAS, visual analog scale.