pharmaceutical department.
deputy director of Jingjiang people's hospital, Jingjiang, Tai Zhou city, Jiangsu province, China.
Medicine (Baltimore). 2020 Dec 18;99(51):e23567. doi: 10.1097/MD.0000000000023567.
This meta-analysis compares the effectiveness of corticosteroid in relieving pain and inflammation in total knee arthroplasty (TKA) patients.
Randomized controlled trials in PubMed (1996 to March 2020), Embase (1996 to March 2020), and the Cochrane Library (CENTRAL, March 2020) compared corticosteroid and placebo in pain in TKA patients were identified by a software and manual searching. The risk of bias and clinical relevance of the included studies were assessed. Sensitivity analysis was performed by omitting each study in turn. The major outcomes of the studies were analyzed by the Stata 12.0.
13 randomized controlled trials that involved 193 patients were included in the present meta-analysis. The results of the study revealed a significantly lower visual analog scale (VAS) score of pain at rest in the corticosteroid group (12 hours: weighted mean difference (WMD)=-1.35, P = .005; 24 hours: WMD=-1.11, P = .000; 48 hours: WMD=-0.31, P = .000; 72 hours: WMD = -0.30, P = .000). And Postoperative VAS scores during mobilization at 12 hours and 24 hours were significantly lower at corticosteroid group when compared with control group (12 hours: WMD = -0.81, P = 0.000; 24 hours: WMD = -1.66, P = .018). Meta-analyses show that administration of corticosteroid can reduce the length of hospital stay, incidence nausea and the C-reactive protein level. While no significant difference was observed in the VAS scores during mobilization at 48 hours and 72 hours and total morphine consumption (P > .05).
Compared to the control group, intraoperative corticosteroid was benefit to the pain management in TKA. However, more high-quality studies are still warranted to further validate our findings, considering there are several limitations in this meta-analysis.
本荟萃分析比较了皮质类固醇在全膝关节置换术（TKA）患者中缓解疼痛和炎症的效果。
通过软件和手动搜索，在 PubMed（1996 年至 2020 年 3 月）、Embase（1996 年至 2020 年 3 月）和 Cochrane 图书馆（CENTRAL，2020 年 3 月）中确定了比较皮质类固醇和安慰剂在 TKA 患者疼痛方面的随机对照试验。评估纳入研究的偏倚风险和临床相关性。通过依次剔除每项研究进行敏感性分析。使用 Stata 12.0 分析研究的主要结局。
本荟萃分析纳入了 13 项随机对照试验，共涉及 193 名患者。研究结果表明，皮质类固醇组在静息时的视觉模拟量表（VAS）疼痛评分明显较低（12 小时：加权均数差（WMD）=-1.35，P=0.005；24 小时：WMD=-1.11，P=0.000；48 小时：WMD=-0.31，P=0.000；72 小时：WMD=-0.30，P=0.000）。与对照组相比，皮质类固醇组术后 12 小时和 24 小时的运动时 VAS 评分明显较低（12 小时：WMD=-0.81，P=0.000；24 小时：WMD=-1.66，P=0.018）。荟萃分析显示，皮质类固醇的给药可以减少住院时间、恶心发生率和 C 反应蛋白水平。而在 48 小时和 72 小时的运动时 VAS 评分和总吗啡消耗量方面，两组之间无显著差异（P＞0.05）。
与对照组相比，术中皮质类固醇有利于 TKA 的疼痛管理。然而，考虑到本荟萃分析存在一些局限性，仍需要更多高质量的研究来进一步验证我们的发现。
