Can intravenous steroid administration reduce postoperative pain scores following total knee arthroplasty?: A meta-analysis

Abstract

Background: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate whether intravenous steroids would result in reduced acute pain and postoperative nausea and vomiting (PONV) among patients undergoing total knee arthroplasty (TKA).

Methods: Electronic databases, including PubMed, Embase, Web of Science, and the Cochrane Library, were searched to identify articles published from database inception to July 2016. RCTs that compared the effects of intravenous steroids with the effects of placebo among patients undergoing TKA were included in this meta-analysis. The primary outcomes were visual analogue scale (VAS) scores after 12, 24, and 48 hours of rest and PONV incidence. The secondary outcomes were blood glucose levels and incidence of infection. We calculated the risk ratio (RR) with its corresponding 95% confidence interval (CI) for dichotomous outcomes and the mean difference (MD) with its corresponding 95% CI for continuous outcomes.

Results: Seven clinical trials involving 434 patients were included in the final meta-analysis. The pooled results indicated that intravenous steroids were associated with decreased VAS scores after 24 hours (MD = -10.21, 95%CI = -18.80 to -1.63, P = .020) and 48 hours (MD = -2.60, 95%CI = -4.70 to -0.50, P = .015) of rest. Moreover, intravenous steroids were also associated with decreased risk of nausea (RR = 0.58, 95% CI 0.44-0.77, P = .000) and vomiting (RR = 0.46, 95% CI = 0.24-0.88, P = .019). However, intravenous steroids were also associated with increased blood glucose levels. No significant difference in the risk of infection was identified between the 2 groups.

Conclusion: Intravenous steroids may be associated with decreased pain intensity and decreased risk of nausea and vomiting during the early period following TKA. However, evidence supporting its use is limited by the low quality of and variations in dosing regimens between the included RCTs. Thus, more high-quality RCTs are needed to identify the optimal drug administration intervals for maximal pain control.

Conflict of interest statement

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

Figures

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 visual analogue scale (VAS) scores between the 2 groups after 12, 24, and 48 hours of rest.

Figure 5

Sensitivity analysis for the differences in visual analogue scale (VAS) scores between the 2 groups after 12, 24, and 48 hours of rest.

Figure 6

Funnel plot of visual analogue scale (VAS) scores after 12, 24, and 48 hours of rest.

Figure 7

Egger test for visual analogue scale (VAS) scores after 12, 24, and 48 hours of rest.

Figure 8

Forest plot comparing the incidence of nausea between the 2 groups.

Figure 9

Subgroup analysis of the incidence of nausea.

Figure 10

Scatterplot comparing steroids dose with the incidence of nausea.

Figure 11

Forest plot comparing the incidence of vomiting between the 2 groups.

Figure 12

Forest plot comparing the incidence of infection between the 2 groups.

Figure 13

Forest plot comparing blood glucose levels upon arrival at the postanesthesia care unit (PACU) and on postoperative day 1 between the 2 groups.