Efficacy of additional corticosteroids to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis of randomized controlled trials

Li, Qi; Mu, Guo; Liu, Xiangbo; Chen, Milian

doi:10.1186/s13018-020-02144-0

Cited by 14 publications

(12 citation statements)

References 40 publications

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“…Cocktail injection anesthesia has been widely used in clinical practice, and studies have shown that this method is ideal for analgesia in TKA [ 13 ], rhinoplasty [ 14 ], and spinal fusion [ 15 ]. A meta-analysis by Li et al [ 16 ], on the efficacy of multimodal cocktail periarticular injections with additional corticosteroids in TKA, showed that multimodal cocktail periarticular injections with glucocorticoids reduced the intensity of early resting pain and increased early knee mobility after knee arthroplasty. The above study confirms that cocktail therapy is indeed effective in controlling postoperative pain and achieving good postoperative results.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Periarticular Injection Cocktail in Postoperative Analgesia after Bilateral Unicompartmental Knee Arthroplasty

Wang¹,

Zhao

Guo

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. This study was conducted to compare postoperative pain and functional recovery in bilateral unicompartmental knee arthroplasty (UKA) and unilateral UKA after cocktail therapy. Methods. A total of 240 patients who received unilateral UKA and bilateral UKA in our orthopedic department from February 2019 to April 2020 were collected. The general clinical data was recorded and compared between the two groups of subjects, and the time of postoperative landing was recorded separately for both groups. A visual analogue scale (VAS) was used to record the patients’ pain at 1, 7, and 14 days postoperatively, as well as the range of motion of the affected limb at 1, 7, 14 days, and 3 months postoperatively and the hospital for special surgery (HSS) knee score of the knee at 1 month postoperatively. Results. After cocktail injection analgesia, unilateral patients with knee surgery got off the ground and walked significantly earlier than patients with bilateral surgery, while there was no significant difference between the two groups in terms of pain at 1, 7, and 14 days after surgery, range of motion of the affected limb at 1, 7, 14 days, and 3 months after surgery, and knee HSS score at 1 month after surgery. Conclusion. Periarticular cocktail injection significantly reduces postoperative pain in patients, and bilateral UKA surgery can be used as satisfactory as unilateral UKA in clinical practice.

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Section: Introductionmentioning

confidence: 99%

The Effects of Periarticular Injection Cocktail in Postoperative Analgesia after Bilateral Unicompartmental Knee Arthroplasty

Wang¹,

Zhao

Guo

et al. 2022

Computational and Mathematical Methods in Medicine

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“…A meta-analysis by Chai et al [22] demonstrated that cocktail analgesia containing corticosteroid periarticular injection did not contribute to pain relief within 12 hours postoperatively; from 24 to 72 hours, it signi cantly decreased the pain score at rest and reduced total rescue opioids. Another meta-analysis study recently by Li et al [23] showed that adding corticosteroids to multimodal cocktail periarticular injection can relieve the POD1, POD2 and POD3 pain intensity at rest after TKA,with no signi cant difference in VAS score at the operation night, POD4, POD5, POD7, and two weeks after the operation. Due to these con icting results, we plan to design a three-arm, double-blinded randomized controlled trial containing a high or normal dose of corticosteroids MCPI, and a noncorticosteroids MCPI to assess its effectiveness in postoperative pain relief, functional improvement, rescue analgesia, and side effects.…”

Section: Discussionmentioning

confidence: 97%

Would High-Dose Corticosteroid Adjuvant To Multimodal Cocktail Periarticular Injection Contribute To Prolonged Pain Control and Better Recovery After Total Knee Arthroplasty?: Study Protocol for a Double-Blinded, Randomized, and Placebo-Controlled Trial

Zhong

He²,

et al. 2021

Preprint

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Background Enhanced recovery after total knee arthroplasty (TKA) has been suggested to enhance postoperative recovery. The use of multimodal cocktail periarticular injection (MCPI) to control the pain of TKA has gained wide acceptance. MCPI containing corticosteroids is believed to be an effective solution because of its local anti-inflammatory effects and ability to reduce the local stress response postoperatively. However, there is conflicting evidence about its benefits. This trial aims to compare MCPI containing a high dose of corticosteroid, MCPI containing anormal dose of corticosteroid, and MCPI without a corticosteroid during TKA to assess the effectiveness of MCPI containing corticosteroid in postoperative pain relief, functional improvement, rescue analgesia and side effects. This will provide evidence regarding the effectiveness of high-dose corticosteroids on prolonged pain control and better recovery after total knee arthroplasty. Methods/design This trial is a double-blinded randomized, placebo-controlled study. A total of 234 patients will be randomized into 3 groups to receive a high dose of betamethasone MCPI (group H), a normal dose of betamethasone MCPI (group N), and a nonbetamethasone MCPI (group C). the following indexes will be recorded and analyzed: knee pain at rest and bending at 90° at 6 h, 24 h, 48 h, 72 h, 5 days, 14 days, and 30 days after surgery; 1-minute walking ability and circumference around patella at 2, 4, 7, 14, and 30 days after surgery; HSS score at 14 and 30 days after surgery; C-reactive protein and blood sedimentation as well as blood sugar at 2, 4, 7, 14, 30 days after surgery; additional morphine analgesics consumption; and side effects. Discussion The results from this study will provide clinical evidence on the effectiveness of MCPI-containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and side effects as well as evidence on the efficacy of high-dose corticosteroids for leading to prolonged pain control and better recovery after TKA. Trial registration Chinese Clinical Trial Registry ChiCTR2000038671. Registered on 27 September 2020

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“…Previous studies have shown the importance of PAS in pain management after TKA [2][3][4][5][6][7][8][9][10][11][12][29][30][31][32] . However, the most recent meta-analysis showed that PAS did not provide pain relief and provided minimal improvement in range of knee movement 33 .…”

Section: Discussionmentioning

confidence: 99%

Pain Relief After Total Knee Arthroplasty with Intravenous and Periarticular Corticosteroid

Chan

Mak

et al. 2023

Journal of Bone and Joint Surgery

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Background:Total knee arthroplasty (TKA) is a cost-effective procedure, but it is also associated with substantial postoperative pain. The present study aimed to compare pain relief and functional recovery after TKA among groups that received intravenous corticosteroids, periarticular corticosteroids, or a combination of both.Methods:This randomized, double-blinded clinical trial in a local institution in Hong Kong recruited 178 patients who underwent primary unilateral TKA. Six of these patients were excluded because of changes in surgical technique; 4, because of their hepatitis B status; 2, because of a history of peptic ulcer; and 2, because they declined to participate in the study. Patients were randomized 1:1:1:1 to receive placebo (P), intravenous corticosteroids (IVS), periarticular corticosteroids (PAS), or a combination of intravenous and periarticular corticosteroids (IVSPAS).Results:The pain scores at rest were significantly lower in the IVSPAS group than in the P group over the first 48 hours (p = 0.034) and 72 hours (p = 0.043) postoperatively. The pain scores during movement were also significantly lower in the IVS and IVSPAS groups than in the P group over the first 24, 48, and 72 hours (p ≤ 0.023 for all). The flexion range of the operatively treated knee was significantly better in the IVSPAS group than in the P group on postoperative day 3 (p = 0.027). Quadriceps power was also greater in the IVSPAS group than in the P group on postoperative days 2 (p = 0.005) and 3 (p = 0.007). Patients in the IVSPAS group were able to walk significantly further than patients in the P group in the first 3 postoperative days (p ≤ 0.003). Patients in the IVSPAS group also had a higher score on the Elderly Mobility Scale than those in the P group (p = 0.036).Conclusions:IVS and IVSPAS yielded similar pain relief, but IVSPAS yielded a larger number of rehabilitation parameters that were significantly better than those in the P group. This study provides new insights into pain management and postoperative rehabilitation following TKA.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Efficacy of additional corticosteroids to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis of randomized controlled trials

Cited by 14 publications

References 40 publications

The Effects of Periarticular Injection Cocktail in Postoperative Analgesia after Bilateral Unicompartmental Knee Arthroplasty

The Effects of Periarticular Injection Cocktail in Postoperative Analgesia after Bilateral Unicompartmental Knee Arthroplasty

Would High-Dose Corticosteroid Adjuvant To Multimodal Cocktail Periarticular Injection Contribute To Prolonged Pain Control and Better Recovery After Total Knee Arthroplasty?: Study Protocol for a Double-Blinded, Randomized, and Placebo-Controlled Trial

Pain Relief After Total Knee Arthroplasty with Intravenous and Periarticular Corticosteroid

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