Hartman Jeffrey, Khanna Vickas, Habib Anthony, Farrokhyar Forough, Memon Muzammil, Adili Anthony
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario L8L2X2, Canada.
Department of Orthopedic Surgery, St. Joseph's Healthcare, Hamilton, Ontario L8N4A6, Canada.
J Orthop. 2017 Apr 12;14(2):294-301. doi: 10.1016/j.jor.2017.03.012. eCollection 2017 Jun.
Perioperative systemic glucocorticoids are frequently included in multimodal analgesia and antiemetic regimens administered to patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The objective of this systematic review was to evaluate the available randomized controlled trials (RCTs) to determine the effect of perioperative systemic glucocorticoids on postoperative nausea and vomiting (PONV), pain, narcotic consumption, antiemetic consumption, length of stay in hospital, and major complications in patients undergoing elective THA or TKA.
A predefined protocol of eligibility and methodology was used for conduct of systematic reviews. Two reviewers screened citations for inclusion, assessed methodological quality, and verified the extracted data.
Six RCTs were included for analysis. Across all outcomes analyzed, patients who received glucocorticoids experienced either a benefit or no difference compared to those patients who did not receive glucocorticoids. There were no instances in which perioperative glucocorticoids had a negative impact on any of the outcomes that were analyzed. Furthermore, perioperative glucocorticoids had no effect on the rates of superficial infection, deep infection, wound complications or deep vein thrombosis (DVT).
The results of this systematic review support the use of perioperative systemic glucocorticoids in patients undergoing elective total hip and knee arthroplasty. Perioperative glucocorticoids have overall positive outcomes with the benefits being more robust in those patients undergoing TKA compared to THA. Glucocorticoids did not increase the occurrence of major complications. There is limited data to support the conclusion that they can reduce length of stay in hospital.
围手术期全身应用糖皮质激素常被纳入全髋关节置换术（THA）和全膝关节置换术（TKA）患者的多模式镇痛和止吐方案中。本系统评价的目的是评估现有随机对照试验（RCT），以确定围手术期全身应用糖皮质激素对择期行THA或TKA患者术后恶心呕吐（PONV）、疼痛、麻醉药物用量、止吐药物用量、住院时间和主要并发症的影响。
采用预先定义的纳入标准和方法学方案进行系统评价。两名评价者筛选纳入的文献、评估方法学质量并核实提取的数据。
纳入六项RCT进行分析。在所有分析的结局中，与未接受糖皮质激素的患者相比，接受糖皮质激素的患者要么有获益，要么无差异。围手术期糖皮质激素对任何分析的结局均未产生负面影响。此外，围手术期糖皮质激素对浅表感染、深部感染、伤口并发症或深静脉血栓形成（DVT）的发生率无影响。
本系统评价结果支持在择期行全髋关节和膝关节置换术的患者中使用围手术期全身应用糖皮质激素。围手术期糖皮质激素总体上有积极的结局，与THA患者相比，TKA患者的获益更明显。糖皮质激素未增加主要并发症的发生。支持其可缩短住院时间这一结论的数据有限。
