Systemic glucocorticoids as an adjunct to treatment of postoperative pain after total hip and knee arthroplasty: A systematic review with meta-analysis and trial sequential analysis
Pooled resultResult — go to the resultReduction 5.0 mg 95% CI 2.2–7.7Authors' conclusion
Peri-operative systemic glucocorticoid treatment reduced postoperative morphine consumption to an individually relevant level following hip and knee arthroplasty. Pain levels were reduced but were below the predefined MID. The quality of evidence was generally low.
Study context
- Population
- Adults (≥18 years) undergoing planned total hip or knee arthroplasty
- Participants
- 3,521 adults · 32 RCTs
- Comparison
- Peri-operative systemic glucocorticoid vs placebo or no intervention
- Outcome
- IV morphine (or equivalent) consumption (MID 5 mg)
- Follow-up
- 24 h
Methodological detailstrial sequential analysis, GRADE, 9 trials at low risk of bias; GRADE quality of evidence low to very low
- Trial sequential analysis
- GRADE
- 9 trials at low risk of bias; GRADE quality of evidence low to very low
Pooled result
As reported in the abstract
Reduction
5.0 mg
95% CI 2.2–7.7
P = 0.0004
Further pooled results
Pain at rest (VAS, minimal important difference (MID) 10 mm) · 6 h
- Pain at rest reduced at 6 h by
- 7.8 mm (95% CI 5.5 to 10.2; P < 0.00001)
- Below predefined MID
Pain at rest (VAS, MID 10 mm) · 24 h
- Pain at rest reduced at 24 h by
- 6.3 mm (95% CI 3.8 to 8.8; P < 0.00001)
- Below predefined MID
Pain during mobilisation (VAS, MID 10 mm) · 6 h
- Pain during mobilisation reduced at 6 h by
- 9.8 mm (95% CI 6.9 to 12.8; P < 0.00001)
- Below predefined MID
Pain during mobilisation (VAS, MID 10 mm) · 24 h
- Pain during mobilisation reduced at 24 h by
- 9.0 mm (95% CI 5.5 to 12.4, P < 0.00001)
- Below predefined MID
Safety
- Incidence of adverse events generally lower with glucocorticoid; Serious adverse events (SAEs) rarely reported
Original publication
Systemic glucocorticoids as an adjunct to treatment of postoperative pain after total hip and knee arthroplasty: A systematic review with meta-analysis and trial sequential analysis. Eur J Anaesthesiol. Published 3 November 2022. doi:10.
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