The efficacy and safety of intravenous glucocorticoids in total hip arthroplasty: A systematic review and meta-analysis.

OBJECTIVE: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the effect and safety of intravenous glucocorticoids for reducing pain scores, postoperative nausea and vomiting (PONV) and total morphine consumption for patients prepared for total hip arthroplasty (THA). METHODS: Electronic databases: PubMed (1950-September 2016), EMBASE(1974-September 2016), the Cochrane Central Register of Controlled Trials (CENTRAL, September 2016 Issue 3) and Web of Science (1950-September 2016) were systematically searched. RCTs compared intravenous glucocorticoids versus placebo for patients prepared for THA were included in this meta-analysis. The primary outcomes were visual analogue scale (VAS) at post anesthesia care unit (PACU), at 24 h and 48 h and the occurrence of PONV. The secondary outcomes was total morphine consumption. We calculated risk ratio (RR) with a 95% confidence interval (CI) for dichotomous outcomes, and the weighted mean difference (WMD) with a 95% CI for continuous outcomes. RESULTS: Five clinical trials involving 255 patients were included for this meta-analysis. The pooled results indicated that intravenous steroids can decrease VAS at PACU (WMD = -10.40, 95% CI -14.18 to -6.62, P < 0.00001; I2 = 0.0%) and total morphine consumption (WMD = -19.71, 95% CI -32.66 to -6.76, P = 0.003; I2 = 57.4%). No significant difference was observed in the VAS at 24 h and 48 h between the intravenous glucocorticoids and placebo groups. Intravenous steroids can decrease the occurrence of PONV (RR = 0.51, 95% CI 0.28 to 0.93, P = 0.029; I2 = 41.2%). The occurrence of PONV tended to decrease as the glucocorticoids dose increased. CONCLUSION: Intravenous glucocorticoids can decrease early pain intensity and PONV after THA. The number of the included studies and the dose of glucocorticoids is different, thus, more high quality RCTs are still needed to identify the optimal drug and the safety of intravenous glucocorticoids.