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

Li, Donghai; Wang, Changde; Yang, Zhouyuan; Kang, Pengde

doi:10.1111/papr.12637

Cited by 39 publications

(28 citation statements)

References 46 publications

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“…According to the outcomes of this meta‐analysis, we found that corticosteroid added to a multimodal cocktail significantly reduced pain scores at rest from POD1 to POD3, decreased postoperative opioid consumption, improved knee ROM from POD1 to POD2, and decreased hospital stays. However, our results suggest that local injection of corticosteroids does not decrease inflammatory cytokines and had no effect on improving postoperative nausea and vomiting, unlike results from previous reviews of intravenous corticosteroids in arthroplasty . However, whether local corticosteroids are comparable to intravenous corticosteroids needs to be studied further.…”

Section: Discussioncontrasting

confidence: 70%

“…However, our results suggest that local injection of corticosteroids does not decrease inflammatory cytokines and had no effect on improving postoperative nausea and vomiting, unlike results from previous reviews of intravenous corticosteroids in arthroplasty. 16 However, whether local corticosteroids are comparable to intravenous corticosteroids needs to be studied further. Our results revealed benefits with postoperative outcomes of TKA when a local injection of corticosteroid was added to a multimodal cocktail.…”

Section: Discussionmentioning

confidence: 99%

“…Corticosteroids are a class of drugs used in various operations for their potent anti‐inflammatory and antiemetic effects . Intravenous administration of corticosteroids is commonly used in joint arthroplasty and has been proven to decrease pain, shorten hospital stays, reduce opioid consumption, and improve nausea and vomiting without increasing adverse events . Surgeons have expanded their use of corticosteroids to local injections in a multimodal effort to control postoperative pain .…”

Section: Introductionmentioning

confidence: 99%

“…11,12 Intravenous administration of corticosteroids is commonly used in joint arthroplasty and has been proven to decrease pain, shorten hospital stays, reduce opioid consumption, and improve nausea and vomiting without increasing adverse events. [13][14][15][16] Surgeons have expanded their use of corticosteroids to local injections in a multimodal effort to control postoperative pain. 17,18 Addition of corticosteroid to local infiltration analgesia has been shown to be safe and appears to be a logical approach in reducing inflammation and improving pain control.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Additional Corticosteroid in a Multimodal Cocktail for Postoperative Analgesia Following Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

et al. 2019

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Background Local injection of a multimodal cocktail including corticosteroid is commonly used for postoperative pain following total knee arthroplasty (TKA). However, it is inconclusive whether additional corticosteroid is beneficial. This meta‐analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy of an additional, local injection of corticosteroid in terms of pain relief and knee function recovery after TKA. Methods RCTs in electronic literature databases including PubMed, Web of Science, Embase, and Cochrane Library were systematically searched. Of 1,628 records identified, 9 RCTs involving 727 knees were eligible for data extraction and meta‐analysis. Results Local injection of a multimodal cocktail including corticosteroid did not contribute to pain relief within 12 hours postoperatively (P > 0.05). However, from 24 hours to 72 hours, it significantly decreased pain scores (P < 0.05, all) at rest and reduced total rescue opioid consumption postoperatively (P < 0.05). Knee range of motion (ROM) was improved at postoperative day 1 (POD1) and POD2 (P < 0.05), and hospital stay (P < 0.05) was shortened after local injection of corticosteroid. However, the other outcomes, including knee ROM after POD2, C‐reactive protein level, Knee Society score, postoperative nausea and vomiting, and wound complication occurrences, were not significantly different (P > 0.05, all). Conclusions Additional corticosteroid added to a multimodal cocktail improved postoperative pain, enhanced knee functional recovery, and shortened hospital stays following TKA, but local injection of corticosteroids had no effect on reducing nausea and vomiting based on our outcomes.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of Additional Corticosteroid in a Multimodal Cocktail for Postoperative Analgesia Following Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

et al. 2019

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“…Post-operative pain can be difficult to control and the lack of relief can lead to significant distress to patients, decreased rehabilitation participation, increased the LOS in the hospital, and increased hospital costs [15][16][17][18][19]. Opioid medications have been a mainstay of pain management strategies following orthopedic surgery; however, due to the ongoing opioid epidemic, new strategies are needed to help curb the reliance on these medications.…”

Section: Discussionmentioning

confidence: 99%

A Collaborative Approach to Pain Control Reduces In-hospital Opioid Use and Improves Range of Motion following Total Knee Arthroplasty

Roberts

Foster

Shi

et al. 2019

Cureus

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Introduction: Opioid pain medications are commonly prescribed following orthopedic procedures, with overprescribing of these pain medications implicated as a driver of the current opioid epidemic. In an effort to reduce reliance on opioid pain medications, surgeons are relying on periarticular injections or peripheral nerve blocks. The purpose of this study was to compare numerical rating scale (NRS) pain scores and oral morphine equivalents (OMEs) in patients who underwent primary total knee arthroplasty (TKA) with a periarticular injection alone to those who underwent a collaborative approach with a periarticular injection in the posterior tissue and an adductor canal catheter for anterior knee analgesia. Methods: In this study, 236 patients underwent a primary TKA between December 2017 and April 2018. Forty patients received an adductor canal catheter and 196 underwent a periarticular injection alone. Results: We found no difference in patient demographics between the cohorts (p>0.05). The patients that underwent the collaborative approach with a periarticular injection and adductor canal catheter had lower NRS pain scores on post-operative day 0, 1, and 2 (all P≤0.033). These patients demonstrated a reduction of 43% in opioid consumption during the hospitalization (P<0.001). These patients also demonstrated improved range of motion (ROM) (96 vs. 92 degrees) on the day of discharge (P=0.013). Conclusion: This study provides strong evidence that in patients undergoing TKA, the collaborative approach with the adductor canal catheter and periarticular injection is associated with lower post-operative pain scores, fewer total OMEs per hospital day, and a greater ROM arc prior to discharge compared to patients receiving a periarticular injection alone.

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Pain Management in Orthopedic Surgery

Uppal

Shanthanna

2021

Evidence‐Based Orthopedics

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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

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

Cited by 39 publications

References 46 publications

Efficacy of Additional Corticosteroid in a Multimodal Cocktail for Postoperative Analgesia Following Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

Efficacy of Additional Corticosteroid in a Multimodal Cocktail for Postoperative Analgesia Following Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

A Collaborative Approach to Pain Control Reduces In-hospital Opioid Use and Improves Range of Motion following Total Knee Arthroplasty

Pain Management in Orthopedic Surgery

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