The efficacy and safety of preoperative glucocorticoids in herniorrhaphy: a systematic review and meta-analysis

Postoperative pain is the main reason for delayed recovery after herniorrhaphy. Preoperative glucocorticoid administration may improve postoperative recovery. The present study assessed the efficacy of preoperative glucocorticoids in facilitating recovery after herniorrhaphy. Randomized controlled trials (RCTs) conducted up to January 2021 were searched in electronic databases and trial registries. Meta-analyses were performed using random effects models. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of evidence. Seven RCTs (744 patients) were included in the meta-analysis. Preoperative glucocorticoid administration reduced patients' pain on postoperative day 0 (standard mean difference [SMD] = - 0.73, 95% confidence interval [CI] - 1.45 to - 0.01; I-2 = 94%). However, there was no marked difference in rescue analgesic use (risk ratio [RR] = - 0.06, 95% CI - 0.28 to - 0.16; I-2 = 0%) or vomiting (RR = 0.78, 95% CI 0.50-1.20; I-2 = 30%) between preoperative glucocorticoid administration and control. The certainty of evidence was moderate because of inconsistencies or imprecision. No serious adverse effects were observed. Preoperative glucocorticoid administration reduced pain in patients following herniorrhaphy without increasing the occurrence of adverse events. Further studies will be required to confirm the efficacy of preoperative glucocorticoids.