Perioperative intravenous glucocorticoids can decrease postoperative nausea and vomiting and pain in total joint arthroplasty A meta-analysis and trial sequence analysis

Background: This meta-analysis aimed to demonstrate the efficacy and safety of intravenous glucocorticoids for reducing pain intensity and postoperative nausea and vomiting (PONV) in patients undergoing total joint arthroplasty (TJA). Methods: PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google databases were searched for randomized controlled trials (RCTs) comparing intravenous glucocorticoids versus no intravenous glucocorticoids or sham for patients undergoing TJA. Outcomes included visual analogue scale (VAS) pain at 12, 24, and 48hours; the occurrence of PONV; length of hospital stay; the occurrence of infection; and blood glucose levels after surgery. We calculated risk ratios (RR) with a 95% confidence interval (CI) for dichotomous outcomes and the weighted mean difference (WMD) with a 95% CI for continuous outcomes. Trial sequential analysis was also used to verify the pooled results. Results: Thirteen clinical trials involving 821 patients were ultimately included in this meta-analysis. The pooled results indicated that intravenous steroids can decrease VAS at 12hours (WMD=-8.54, 95% CI -11.55 to -5.53, P=0.000; I-2=35.1%), 24hours (WMD=-7.48, 95% CI -13.38 to -1.59, P=0.013; I-2=91.8%), and 48hours (WMD=-1.90, 95% CI -3.75 to -0.05, P=0.044; I-2=84.5%). Intravenous steroids can decrease the occurrence of PONV (RR=0.56, 95% CI 0.44-0.73, P=0.000; I-2=33.1%). There was no significant difference in the length of hospital stay, occurrence of infection, and blood glucose levels after surgery. Conclusion: Intravenous glucocorticoids not only alleviate early pain intensity but also decrease PONV after TJA. More high-quality RCTs are required to determine the safety of glucocorticoids before making final recommendations.