Effect of Intravenous Corticosteroids on Pain Management and Early Rehabilitation in Patients Undergoing Total Knee or Hip Arthroplasty: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Corticosteroids are frequently used for the treatment of postoperative nausea and vomiting, and have also been reported to have an effect on postoperative analgesia. This study was conducted to assess the pain management effect of perioperative intravenous corticosteroids in patients undergoing total knee or hip arthroplasty and evaluate their early rehabilitation.

METHOD: Randomized controlled trials (RCTs) were searched from electronic databases, including PubMed, Web of Science, Embase (Ovid interface), and the Cochrane Library (Ovid interface). Among 932 records identified, 14 RCTs involving 1,023 patients were eligible for data extraction and meta-analysis.

RESULTS: The use of intravenous steroids was associated with reduced pain at rest and with activity during the first 24 hours after operation (P < 0.05). Patient steroid groups had less opioid consumption (P < 0.05). Additionally, patients using intravenous corticosteroids had better outcomes, in terms of nausea and vomiting (both P < 0.05). Moreover, corticosteroids were effective in decreasing the inflammatory marker interleukin-6 (P < 0.05). Complications such as deep infection and pruritus showed similar occurrence in both the corticosteroid groups and control groups (P > 0.05), while the occurrence of venous thromboembolism was lower in the corticosteroid groups, with a marginally significant difference. In addition, no significant difference in length of hospital stay was observed, irrespective of whether patients received intravenous corticosteroids (P > 0.05).

CONCLUSION: Our results show that intravenous corticosteroids have good efficacy and safety when used perioperatively in total knee or hip arthroplasty.