The efficiency and safety of dexamethasone for pain control in total joint arthroplasty: A meta-analysis of randomized controlled trials

Jian Meng, Lin Li, Jian Meng, Lin Li

Abstract

Background: This meta-analysis aimed to evaluate the efficiency and safety of dexamethasone administration in total knee and hip arthroplasties.

Methods: Two researchers search the relevant studies independently including Embase (1980-017.04), PubMed (1966-017.04), ScienceDirect (1985-017.04), Web of Science (1950-2017.03), and Cochrane Library for potential relevant studies. After testing for heterogeneity between studies, data were aggregated for random-effects models when necessary. The results of dichotomous outcomes were expressed as risk difference (RD) with a 95% confidence intervals (CIs). For continuous various outcomes, mean difference (MD) or standard mean difference (SMD) with a 95% confidence intervals (CIs) was applied for assessment. Meta-analysis was performed using Stata 11.0 software.

Results: Four randomized controlled trials (RCTs) including 361 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of visual analogue scale (VAS) score at 12 hours (SMD = -0.579, 95% CI: -0.780 to -0.357, P = .000), 24 hours (SMD = -0.820, 95% CI: -1.036 to -0.604, P = .000), and 48 hours (SMD = -0.661, 95% CI: -1.149 to -0.172, P = .008). Dexamethasone was associated with a lower opioid consumption at 12 hours (SMD = -0.245, 95% CI: -0.465 to -0.025, P = .029), 24 hours (SMD = -0.285, 95% CI: -0.505 to -0.064, P = .011), and 48 hours (SMD = -0.989, 95% CI: -1.710 to -0.267, P = .007).

Conclusion: Dexamethasone could significantly reduce postoperative pain scores and opioid consumption within the 1st 48 hours following total joint arthroplasty (TJA). The overall evidence quality was moderate to low, further high-quality RCTs are needed to identify the optimal dose of dexamethasone for reducing pain after TJA.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Search results and the selection procedure.
Figure 2
Figure 2
Forest plot diagram showing VAS scores at 12 hours following TJA. TJA = total joint arthroplasty, VAS = visual analogue scale.
Figure 3
Figure 3
Forest plot diagram showing VAS scores at 24 hours following TJA. TJA = total joint arthroplasty, VAS = visual analogue scale.
Figure 4
Figure 4
Forest plot diagram showing VAS scores at 48 hours following TJA. TJA = total joint arthroplasty, VAS = visual analogue scale.
Figure 5
Figure 5
Forest plot diagram showing opioid consumption at 12 hours following total joint arthroplasty (TJA).
Figure 6
Figure 6
Forest plot diagram showing opioid consumption at 24 hours following total joint arthroplasty (TJA).
Figure 7
Figure 7
Forest plot diagram showing opioid consumption at 48 hours following total joint arthroplasty (TJA).
Figure 8
Figure 8
Forest plot diagram showing length of stay following total joint arthroplasty (TJA).
Figure 9
Figure 9
Forest plot diagram showing incidence of nausea following total joint arthroplasty (TJA).
Figure 10
Figure 10
Forest plot diagram showing incidence of vomiting following total joint arthroplasty (TJA).

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Source: PubMed

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