Department of Orthopedics, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, 450016, China.
Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, 450003, China.
Int J Surg. 2018 Sep;57:91-100. doi: 10.1016/j.ijsu.2018.07.009. Epub 2018 Aug 16.
BACKGROUND: Pain management after arthroplasties has become a serious problem. We perform a meta-analysis from randomized controlled trial (RCTs) to examine the efficacy and safety of methylprednisolone in the setting of postoperative pain after total knee arthroplasty (TKA). METHODS: We conduct electronic searches of Medline (1966 to October 2017), Embase (1980 to October 2017), ScienceDirect (1985 to October 2017) and the Web of Science (1995 to October 2017). Eligibility criteria: (1) Participants: Published studies enrolling adult human subjects with knee osteoarthritis who prepare for TKA are included in our study; (2) Interventions: The intervention groups receive methylprednisolone in the management of postoperative pain; (3) Comparisons: The control groups receive placebo; (4) Outcomes: The primary outcomes are visual analogue scale (VAS) scores and narcotic consumption. The secondary outcomes include adverse effects (gastrointestinal events and pruritus) and postoperative complications (deep venous thrombosis, pulmonary embolism and infection); (5) Study design: RCTs. Fixed/random effect model is adopted according to the heterogeneity tested by I statistic. Stata 11.0 software is used to perform the meta-analyses. RESULTS: Four RCTs involving 248 patients are included. The present meta-analysis indicates that there are significant differences between groups regarding pain score at 6 h (WMD = -0.661, 95% CI: -1.152 to -0.171, P = 0.008), 12 h (WMD = -0.555, 95% CI: -1.091 to -0.018, P = 0.043) and 24 h (WMD = -0.648, 95% CI: -1.146 to -0.150, P = 0.011) after TKA. Significant differences are found in terms of narcotic consumption at 6 h (WMD = -3.453, 95% CI: -6.116 to -0.791, P = 0.011), 12 h (WMD = -5.138, 95% CI: -9.036 to -1.240, P = 0.010) and 24 h (WMD = -3.651, 95% CI: -5.909 to -1.393, P = 0.002). CONCLUSION: Methylprednisolone could significantly decrease postoperative pain score, narcotic consumption and opioid-related adverse effects after TKA. Further high-quality RCTs are still required to validate the results.
背景：关节置换术后的疼痛管理已成为一个严重的问题。我们进行了一项荟萃分析，纳入了随机对照试验（RCT），以评估甲泼尼龙在全膝关节置换术（TKA）后术后疼痛中的疗效和安全性。
方法：我们对 Medline（1966 年至 2017 年 10 月）、Embase（1980 年至 2017 年 10 月）、ScienceDirect（1985 年至 2017 年 10 月）和 Web of Science（1995 年至 2017 年 10 月）进行了电子检索。纳入标准：（1）参与者：纳入准备接受 TKA 的膝骨关节炎成年人类受试者的研究；（2）干预措施：干预组接受甲泼尼龙治疗术后疼痛；（3）比较：对照组接受安慰剂；（4）结局：主要结局为视觉模拟评分（VAS）和阿片类药物用量。次要结局包括不良反应（胃肠道事件和瘙痒）和术后并发症（深静脉血栓形成、肺栓塞和感染）；（5）研究设计：RCT。根据 I 统计检验的异质性，采用固定/随机效应模型进行荟萃分析。采用 Stata 11.0 软件进行荟萃分析。
结果：纳入了四项涉及 248 名患者的 RCT。本荟萃分析表明，两组在 TKA 后 6 小时（WMD=−0.661，95%CI：−1.152 至−0.171，P=0.008）、12 小时（WMD=−0.555，95%CI：−1.091 至−0.018，P=0.043）和 24 小时（WMD=−0.648，95%CI：−1.146 至−0.150，P=0.011）的疼痛评分存在显著差异。在 TKA 后 6 小时（WMD=−3.453，95%CI：−6.116 至−0.791，P=0.011）、12 小时（WMD=−5.138，95%CI：−9.036 至−1.240，P=0.010）和 24 小时（WMD=−3.651，95%CI：−5.909 至−1.393，P=0.002）的阿片类药物用量方面也存在显著差异。
结论：甲泼尼龙可显著降低 TKA 后术后疼痛评分、阿片类药物用量和阿片类药物相关不良反应。仍需要进一步的高质量 RCT 来验证这些结果。
Medicine (Baltimore). 2018-8
Curr Pain Headache Rep. 2024-9
Zotero 插件