The efficacy and safety of perioperative glucocorticoid for total knee arthroplasty: a systematic review and meta-analysis

Liu, Fangyan; Duan, Mei; Fu, Huiqun; Wang, Tianlong

doi:10.1186/s12871-024-02530-9

Table 1 Characteristic of the included studies

From: The efficacy and safety of perioperative glucocorticoid for total knee arthroplasty: a systematic review and meta-analysis

Study	Year	Country	Sample size	Mean age	Gender (M:F) (I/C)	Anesthesia	Intervention	Pain manage	Relevant outcome	Follow-up
Study	Year	Country	(I/C)		Gender (M:F) (I/C)	Anesthesia	Intervention	Pain manage	Relevant outcome	Follow-up
Gasbjerg et al. [17]	2022	Danish	161/162	69/68	80:81/74:88	S/G	24 mg DXM prior surgery	Oral paracetamol and ibuprofen prior and after surgery, LIA, PCA (morphine), Morphine for rescue analgesia.	VAS and adverse effects	3 months
Lei et al. [18]	2021	China	62/63	66.0 /66.0	12:50/8:55	G	10 mg DXM prior to induction	LIA, oral diclofenac or an IM of morphine as required.	VAS, ROM, Inflammatory cytokines and adverse effects	3 months
Cheng et al. [19]	2021	China	49/49^a	63.7/64.8	10:45/12:43	S	Oral prednisone (10 mg qd, from pod1, for 2 weeks)	Oral celecoxib prior surgery, LIA, celecoxib on pod1 and tramadol for 2 weeks.	VAS and adverse effects	3 months
Zhang et al. [20]	2020	China	31/32	66.3/67.3	6:25/4:28	G	20 mg DXM after anesthesia, 10 mg DXM at 24 and 48 h	PIA, enteric-coated diclofenac sodium bid.	Inflammatory cytokines and adverse effects	1 year
Tammachote and Kanitnate [21].	2020	Thailand	50/50	67 /69	8:42/6:44	S	0.15 mg/kg DXM after anesthesia	PIA, IV ketorolac or morphine as required during the pod2, oral naproxen, oral tramadol as required on pod3. Extended-released acetaminophen, nortriptyline and pregabalin at bedtime.	VAS, ROM and adverse effects	3 months
Kim et al. [22]	2020	Korea	45/44	69.3 /68.2	4:41/3:41	S	10 mg DXM 1 h prior surgery	PIA, PCA (fentanyl and Acupan), oral celecoxib, tramadol/acetaminophen, oral oxycodone, IV pethidine or fentanyl patches as emergency required.	VAS and adverse effects	1 week
Chan et al. [23]	2020	China	46/45	75.5/75.3	11:35/13:32	S	8 mg DXM prior induction	LIA, PCA morphine, oral analgesic regimen (pregabalin, paracetamol and celecoxib).	VAS, ROM, Inflammatory cytokines and adverse effects	1 year
Yu et al. [24]	2019	China	45/43	65.1/64.2	19:26/17:26	G	10 mg DXM after the anesthesia and repeated at 24 h	Oral oxycodone or an IM of pethidine hydrochloride as required.	VAS, ROM, Inflammatory cytokines and adverse effects	3 months
Chen et al. [25]	2019	China	30/30	66.7/68.1	8:22/8:22	S	125 mg MP on the induction	LIA, PCA Morphine, Oral or IV medications (Gabapentin, Esomeprazole, Paracetamol, Cefazolin, Tranexamic acid, Etoricoxib, Bisacodyl, Metoclopramide, Dihydrocodeine).	Inflammatory cytokines and adverse effects	1 year
Xu et al. [26]	2018	China	60/61	64.5/65.8	11:49/8:53	G	20 mg DXM prior induction	PAI, oral diclofenac, oxycodone HCl or IM of morphine as required.	VAS, ROM, Inflammatory cytokines and adverse effects	3 months
Wu et al. [27]	2018	China	50/50	66.9/67.4	17:33/18:32	G	10 mg DXM 1 h prior surgery	MOAG from 1 day prior operation (celecoxib, pregabalin), oral oxycodone or an IM of pethidine hydrochloride as required.	VAS, ROM, Inflammatory cytokines and adverse effects	3 months
Li et al. [28]	2018	China	36/32	63.9 /64.7	7:29/5:27	NR	100 mg HC, 2 h prior and 8 h after surgery	Oral celecoxib, LIA, PCA, IM of pethidine hydrochloride as required.	VAS, ROM and adverse effects	30 days
Dissanayake et al. [29]	2018	Australia	41/40	NR	NR	S/G	8 mg DXM at induction and at 24 h	LIA, paracetamol, gabapentin for 2,3 days post-surgery, oxycodone/naloxone for 4,5 days, ibuprofen or celecoxib, oxycodone and tramadol slow release as required.	VAS and adverse effects	6 weeks
Xu et al. [30]	2018	China	54/54	63.6 /63.6	8:46/9:45	G	10 mg DXM after anesthesia, 10 mg DXM returned to the inpatient unit	PIA, MOAG from 1 day prior operation (diclofenac, pregabalin), oral oxycodone or an IM of parecoxib as required.	VAS, ROM, Inflammatory cytokines and adverse effects	3 days
Lindberg-Larsen et al. [31]	2017	Denmark	33/30	65.0/67.7	13:20/15:15	S	125 mg MP after anesthesia	Oral paracetamol, naproxen 1 h prior surgery, LIA, oral paracetamol and naproxen. Opioids as request.	VAS, Inflammatory cytokines and adverse effects	24 h
Lee et al. [32]	2018	Canada	60/60	64.6/67	18:42/23:37	S	8 mg DXM over 10 min after block	Oral acetaminophen before surgery, LIA, PCA hydromorphone, oral acetaminophen, oral opioids (hydromorphone or oxycodone), IV ketorolac or subcutaneous opioids as needed,	VAS and adverse effects	48 h
Morales-Munoz et al. [33]	2015	Spain	27/27^b	68.8/68.8	8:19/6:21	S	8 mg DXM	0.5% ropivacaine (20 ml) for FNB	VAS and adverse effects	48 h
McLawhorn et al. [34]	2015	America	11/12	68/66	3:8/3:9	S	100 mg HSS 2 h prior surgery, 2 more doses given 8 h	PECA till day 2, acetaminophen and oral narcotic analgesics as needed	Adverse effects	hospital stay
Backes et al. [35]	2013	America	28/20	NR	NR	G	10 mg DXM prior to induction	Oral extended release oxycodone, celecoxib prior surgery, intraarticular pain pumps of 0.5% bupivacaine, PCA hydromorphone, oral extended release oxycodone, hydrocodone/acetaminophen and/or IV hydromorphone as request.	ROM	48 h
Koh et al. [36]	2013	Korea	135/134	72.0/72.0	38:117/35:119	S	10 mg DXM 1 h prior surgery	MOAG prior surgery (sustained-release oxycodone, celecoxib, pregabalin and acetaminophen), Continuous FNB, PIA, PCA fentanyl, Oral celecoxib, pregabalin and acetaminophen or IM of ketoprofen as required.	VAS and adverse effects	1 year
Lunn et al. [37]	2011	Denmark	24/24	66/67	13:11/8:16	S	125 mg MP prior anesthesia	LIA, IV sufentanil in PACU, oral oxycodone, celecoxib and slow-release acetaminophen, oral gabapentin and from the night of surgery up to the 6th.	VAS, Inflammatory cytokines and adverse effects	30 days
Jules-Elysee et al. [38]	2011	America	15/15^c	64 /71	6:9/9:6	S	100 mg HC prior surgery, 2 dose eight hours apart	PECA(bupivacaine and hydromorphone), bilateral FNBs, oxycodone and acetaminophen as needed	VAS, Inflammatory cytokines and adverse effects	6 months
Peng et al. [39]	2021	China	60/60^c	65.1/65.1	4:56/4:56	NR	7 mg betamethasone	PIA, PCA (morphine), parecoxib after for 3 days and oral Loxoprofen Sodium, aminophenol oxycodone sed as emergency.	VAS, ROM and adverse effects	3 months
Wang et al. [40]	2021	China	52/50	65.1/63.9	17:35/15:35	G	10 mg DXM	LIA, celecoxib, morphine hydrochloride injected subcutaneously as required.	VAS, ROM, Inflammatory cytokines and adverse effects	3 months
El-Boghdadly et al. [41]	2021	United Kingdom	68/72^a	63.1/65.8	34:34/25:47	S	8 mg DXM	Oral acetaminophen and celecoxib preoperatively, LIA, IV fentanyl or hydromorphone at PACU, oral acetaminophen celecoxib. Oral oxycodone, hydromorphone or PCA with hydromorphone or morphine as request.	VAS, ROM and adverse effects	1 month
Chan et al. [42]	2020	China	45/45^c	66/66	31:14:/31:14	S	40 mg TA	LIA, PCA.	VAS, ROM and adverse effects	1 year
Tsukada et al. [43]	2016	Japan	40/37	75 /72	5:35/5:32	S	40 mg MP	LIA, IV flurbiprofen axetil, oral loxoprofen, diclofenac sodium as request.	VAS, ROM and adverse effects	1 year
Kim et al. [44]	2015	Korea	43/43	71.4/70.6	2:41/4:39	S	40 mg MP	Oral celecoxib and tramadol/acetaminophen for pre 1 day, LIA, PCA (fentanyl), Ketorolac and fentanyl patch for 3—6 day. Oral celecoxib, tramadol/acetaminophen. IM of pethidine or oral oxycodone was used on rescue.	VAS, ROM, Inflammatory cytokines and adverse effects	7 days
Ikeuchi et al. [45]	2014	Japan	20/20	77 /76	2:18/4:16	G	6.6 mg DXM	LIA, PCA (Fentanyl), oral loxoprofen tablets until POD5 and as needed.	VAS, Inflammatory cytokines and adverse effects	3 months
Kwon et al. [46]	2014	Korea	76/76^c	69.3/69.3	0:76/0:76	S	40 mg TA	Oral celecoxib, ultracet and pregabalin prior operation, LIA, PCA (fentanyl and bupivacaine), oral celecoxib and ultracet bid. IM of ketoprofen as request.	Adverse effects	6 months
Yue et al. [47]	2013	China	36/36	70.2/69.3	4:32/4:32	G	1 ml betamethasone	Oral celecoxib preoperatively and postoperatively, LIA, PCA (morphine), IM of morphine as required.	VAS, ROM and adverse effects	1 year
Chia et al. [48]	2013	Australia	39/40	68.9 /65.1	NR	S	40 mg triamcinolone acetate	LIA, celecoxib for 2 weeks.	VAS, ROM and adverse effects	3 months
Seah et al. [49]	2011	Singapore	50/50	67.9/65.4	NR	S/G	40 mg TA	LIA, oral naproxen and PCA (morphine).	VAS, ROM and adverse effects	2 year
Christensen et al. [50]	2009	America	39/37	65.8/65.2	16:23/7:30	G	40 mg MP acetate	Oral celecoxib, oxycodone and acetaminophen preoperatively, FNB, LIA,	VAS, ROM and adverse effects	3 months
Li et al. [51]	2021	China	45/45	66.1/68.2	15:30/8:37	G	10 mg DXM at the induction, 10 mg DXM, 100 ml	Oral loxoprofen or celecoxib after hospital admission, LIA, oral Loxoprofen, IM parecoxib until hospital discharge, IM Morphine hydrochloride as required.	VAS, ROM, Inflammatory cytokines and adverse effects	3 months
Hatayama et al. [52]	2021	Japan	50/50	71.6 /72.3	12:38/5:45	G	10 mg DXM 1 h prior, 24 h after surgery, 40 mg TA	PIA, FNB, oral acetaminophen on pod1, IM pentazocine and transrectal administration of diclofenac as request.	VAS, Inflammatory cytokines and adverse effects	1 week

I/C Interventional group/Control group, M/F Male/Female, NR not rated, S/G Intraspinal anesthesia/General anesthesia, DXM dexamethasone, MP methylprednisolone, HC hydrocortisone, TA triamcinolone acetonide, HSS hydrocortisone sodium succinate, LIA local infiltration analgesia, PIA periarticular infiltration analgesia, PCA patient-controlled intravenous analgesia, PCEA patient-controlled epidural analgesia, MOAG multimodal oral analgesic drugs, IM muscular injection, IV intravenous injection; FNB, femoral nerve block, VAS Visual analgesia score, ROM Range of Motion
^aFinal analyzed
^bKnee replacement surgery
^cBilateral TKA

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