A meta-analysis of clinical efficacy and safety of intravenous glucocorticoids before lower limb joint arthroplasty

doi:10.12307/2025.118

Abstract

Abstract: OBJECTIVE: The clinical efficacy and safety of preoperative intravenous glucocorticoids in patients undergoing lower limb joint arthroplasty remain controversial. Therefore, we conducted a meta-analysis based on randomized controlled trials to evaluate the efficacy and safety of preoperative intravenous glucocorticoids for clinical treatment using lower limb joint arthroplasty.
METHODS: We systematically searched randomized controlled trials on the effects of preoperative intravenous glucocorticoids on the efficacy and safety of lower limb joint arthroplasty in Chinese and foreign databases up to June 2023, including PubMed, Embase, Web of Science, Cochrane Library, WanFang Data, and CNKI. The trial group was injected with intravenous glucocorticoid before operation to control pain. The control group received placebo or intravenous saline. Outcome measures included postoperative resting pain score, postoperative C-reactive protein, postoperative 5-m walking test pain score, length of hospital stay, operation time, postoperative morphine opioid supplemental dose, postoperative nausea and vomiting reaction, and postoperative periprosthesis infection complications.
RESULTS: (1) A total of nine randomized controlled trials included 613 patients (n=311 in the glucocorticoid group, n=302 in the control group). (2) Compared with the control group, preoperative intravenous administration of glucocorticoids significantly reduced the resting pain scores of patients at 6 and 12 hours after surgery, as well as the pain scores of patients walking for 5 m on the first day after surgery. In addition, the need for additional morphine opioids and postoperative nausea and vomiting were reduced in the glucocorticoid group. The inflammatory C-reactive protein was lower than that of the control group within three days after surgery, and the length of hospital stay was shortened after intravenous glucocorticoid injection (P < 0.05). (3) However, there were no significant differences in the incidence of infection after arthroplasty, operation time, and pain scores at 24 and 48 hours between the two groups.
CONCLUSION: As an effective perioperative multi-modal analgesia protocol, intravenous injection of glucocorticoids before surgery is an effective and safe method to reduce hyperacute pain and improve joint mobility in patients with lower limb joint arthroplasty. More research is needed to determine the optimal dose and type of glucocorticoids for maximum pain control.

Key words: arthroplasty, glucocorticoids, postoperative pain, security, meta-analysis

CLC Number:

Wang Jianlei, He Peiliang, Sun Yongjian. A meta-analysis of clinical efficacy and safety of intravenous glucocorticoids before lower limb joint arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(3): 599-607.

Figures/Tables 8

2.4 Meta分析结果 2.4.1 术后6，12，24，48 h静息疼痛评分 5项研究报告了两组下肢关节置换术后6 h的静息疼痛评分[7，9，11，13-14]，纳入的研究之间存在很大的异质性(I2=93%，P < 0.000 01)，故用随机效应模型进行分析。与对照组相比，糖皮质激素组患者术后6 h VAS评分明显降低，差异有显著性意义(SMD =-1.06，95%CI：-1.96至-0.15，P=0.02)，见图5。有3项研究报告了两组术后12 h 的静息时疼痛评分[7，9，11]，纳入的研究之间存在较大异质性(I2= 89%，P=0.000 1)。与对照组相比，糖皮质激素患者组术后12 h VAS评分降低，差异有显著性意义(MD =-2.44，95%CI：-3.57至-1.31，P < 0.000 1)，见图6。 9项研究报告了两组术后24 h的静息疼痛评分[7-15]，其中4项使用VAS疼痛评分[7，9，11，15]，5项使用NRS疼痛评分[8，10，12-14]，因为VAS和NRS是2个疼痛评分系统，合并后异质性较大，所以按照不同评分分为VAS及NRS评分2个亚组，亚组分析显示，两组术后24 h疼痛评分差异无显著性意义(Z=0.14，P=0.89)，见图7。 4项研究报告了两组术后48 h的静息时疼痛评分[8-9，13，15]，纳入的研究无异质性(I2=0%，P=0.5)。与对照组相比，糖皮质激素组患者的术后48 h静息VAS疼痛评分无显著性差异(MD=0.06，95%CI：-0.15-0.26，P=0.58)，见图8。 2.4.2 术后第1天下地行走5 m疼痛评分 4项研究报告了两组在术后第1天下地行走5 m疼痛评分[8，12-14]，纳入的研究有异质性(I2=80%， P=0.03)。与对照组相比，糖皮质激素组患者术后第1天下地行走5 m的疼痛评分相对降低(SMD=1.05，95%CI：0.07-2.02，P=0.03)，见图9。 2.4.3 术后阿片类药物需要量 6项涉及448例患者的研究报告了术后追加阿片类药物的情况[7-12]，经分析纳入的研究之间异质性较小(I2=14%，P=0.33)，故使用固定效应模型用于汇集数据。两组之间差异有显著性意义，糖皮质激素组术后阿片类药物需要量减少(MD =-0.15，95%CI：-0.16至-0.13，P < 0.000 01)，见图10。 2.4.4 术后发生恶心呕吐反应 4项研究报告了患者出现恶心呕吐[9，13-15]，纳入的研究无明显异质性(I2=0%，P=0.86)。因此，使用固定效应模型来汇集数据。与对照组相比，糖皮质激素组患者术后恶心呕吐发生率显著降低(7.4% vs. 30.8%，OR=0.18，95%CI：0.08-0.41，P < 0.000 1)，见图11。"

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