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

• Published in: Medicine (Baltimore) 2017-11, Vol.96 (47), p.e8804-e8804
• Main Authors: Yang, Qing, Zhang, Zhi, Xin, Wenqi, Li, Aixiang
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Aged; Analgesics, Opioid - administration & dosage; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; Female; Glucocorticoids - administration & dosage; Humans; Male; Middle Aged; Morphine - administration & dosage; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Postoperative Nausea and Vomiting - drug therapy; Postoperative Nausea and Vomiting - etiology; Preoperative Care - methods; Randomized Controlled Trials as Topic; Systematic Review and Meta-Analysis; Treatment Outcome
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000008804

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). 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. Pooled data from 7 RCTs (411 THAs) favored preoperative intravenous glucocorticoids against acute pain intensity at 4, 24, and 48 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). 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.