Chilmi Mohammad Zaim, Sugianto Julius Albert, Putra Zainurrahman Kurnia, Hanum Puri Safitri, Ulfa Maria
Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Master of Hospital Administration, Postgraduate Program, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia.
J Orthop. 2023 Jul 20;43:11-16. doi: 10.1016/j.jor.2023.07.015. eCollection 2023 Sep.
Combining steroids for a periarticular injection (PAI) regiment has resulted in better pain control for postoperative TKR pain. Despite the available evidence, the most effective type of steroid for PAI still needs to be established. Network meta-analysis is conducted to analyze whether there is any difference in the effect of particulate compared to non-particulate periarticular steroid injection on post-TKR patients for pain control based on published literature.
This study is conducted following the PRISMA guideline. In general, studies assessing the efficacy of periarticular injection analgesia added with either particulate (Triamcinolone, methylprednisolone, or prednisolone) or non-particulate (dexamethasone or betamethasone) steroid compared to the same regiment were analyzed.
Ten studies were finally included from the 108 identified papers through database searching. VAS reduction on POD1 is found to be similar in particulate (0,91; CI95%: 0,45-1,37) compared to non-particulate (0,81; CI95%: 0,34-1,28) (Fig. 2). The difference becomes wider and favors non-particulate POD3. Subgroup analysis based on each steroid type was conducted. A stark difference can be observed for each pair of steroids (particulate and non-particulate), resulting in a similar cumulative effect of particulate and non-particulate steroids and inconsistent result on POD1 compared to POD3.
From the available evidence, we concluded that particulate or non-particulate steroid does not significantly affect post-TKR pain management. Instead, the specific type of steroid contributes more to postoperative VAS reduction.
Level III.
联合使用类固醇进行关节周围注射（PAI）方案可更好地控制全膝关节置换术（TKR）后的疼痛。尽管有现有证据，但PAI最有效的类固醇类型仍有待确定。基于已发表的文献，进行网状Meta分析，以分析颗粒状与非颗粒状关节周围类固醇注射对TKR术后患者疼痛控制效果的差异。
本研究遵循PRISMA指南进行。一般来说，分析了评估添加颗粒状（曲安奈德、甲泼尼龙或泼尼松龙）或非颗粒状（地塞米松或倍他米松）类固醇的关节周围注射镇痛效果与相同方案相比的研究。
通过数据库检索，从108篇已识别的论文中最终纳入了10项研究。发现术后第1天（POD1）颗粒状类固醇（0.91；95%置信区间：0.45-1.37）与非颗粒状类固醇（0.81；95%置信区间：0.34-1.28）的视觉模拟评分（VAS）降低相似（图2）。差异在术后第3天（POD3）变得更大，且有利于非颗粒状类固醇。进行了基于每种类固醇类型的亚组分析。每对类固醇（颗粒状和非颗粒状）之间可观察到明显差异，导致颗粒状和非颗粒状类固醇的累积效果相似，且与POD3相比，POD1的结果不一致。
根据现有证据，我们得出结论，颗粒状或非颗粒状类固醇对TKR术后疼痛管理无显著影响。相反，特定类型的类固醇对术后VAS降低的作用更大。
三级。
