Total Hip, Knee Arthroplasty Pain Relieved by IV Corticosteroids

The use of perioperative intravenous (IV) corticosteroids provides effective pain relief, has a favorable safety profile, and is associated with a reduction in opioid use in patients undergoing total knee or hip arthroplasty, according to a meta-analysis published in Pain Practice.¹

Researchers evaluated 14 randomized controlled trials conducted in patients who had undergone total knee or hip arthroplasty and received IV corticosteroids postoperatively (n=1023). For the final analysis, patients were divided into a corticosteroids group (n=542) and a control group (n=481).

Patients who had received perioperative corticosteroids reported significantly lower pain scores — as assessed using visual analog and numeric rating scales — at 8 hours (standardized mean differences [SMD], -1.12; 95% CI, -2.11 to -0.14; I²=96%) and during physical activity within the first 24 hours following the intervention (SMD, -3.18; 95% CI, -4.85 to -1.51; I²=97%; P <.05) than patients in the control group. No significant differences in pain scores were observed at 48 hours following the intervention.

Patients receiving steroids also required significantly fewer opioid medications than patients in the control group (SMD, -0.70; 95% CI, -1.39 to -0.02; I²=89%; P <.05). Investigators also found a greater reduction in interleukin-6 levels in patients receiving corticosteroids (P <.05). There were no differences between the groups in terms of length of hospital stay (mean differences [MD], -0.42; 95% CI, -0.92 to -0.07; I²=85%).

Nausea and vomiting were less frequent in the corticosteroids group (odds ratio [OR], 0.48; 95% CI, 0.35 to 0.67; I²=11% and OR, 0.33; 95% CI, 0.21 to 0.52; I²=0%, respectively; P <.05 for both).

This study included literature that reported the use of many different corticosteroid medications at varying dosages, which limits the ability to determine the effects of specific steroids.

Since opioids used in surgery can increase the risk for nausea and vomiting and for dependence, the researchers emphasize the benefits of IV corticosteroids for reducing opioid requirements and serving as “antiemetics and anti-nausea in joint arthroplasty.”

Reference

1. Li D, Wang C, Yang Z, Kang P. Effect of intravenous corticosteroids on pain management and early rehabilitation in patients undergoing total knee or hip arthroplasty: A meta-analysis of randomized controlled trials. Pain Practice [published online August 29, 2017]. doi:10.1111/papr.12637

This article originally appeared on Clinical Pain Advisor