The efficiency and safety of dexamethasone for pain control in total joint arthroplasty A meta-analysis of randomized controlled trials

Background: This meta-analysis aimed to evaluate the efficiency and safety of dexamethasone administration in total knee and hip arthroplasties. Methods: Two researchers search the relevant studies independently including Embase (1980-017.04), PubMed (1966-017.04), ScienceDirect (1985-017.04), Web of Science (1950-2017.03), and Cochrane Library for potential relevant studies. After testing for heterogeneity between studies, data were aggregated for random-effects models when necessary. The results of dichotomous outcomes were expressed as risk difference (RD) with a 95% confidence intervals (CIs). For continuous various outcomes, mean difference (MD) or standard mean difference (SMD) with a 95% confidence intervals (CIs) was applied for assessment. Meta-analysis was performed using Stata 11.0 software. Results: Four randomized controlled trials (RCTs) including 361 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of visual analogue scale (VAS) score at 12hours (SMD=-0.579, 95% CI: -0.780 to -0.357, P=.000), 24hours (SMD=-0.820, 95% CI: -1.036 to -0.604, P=.000), and 48 hours (SMD=-0.661, 95% CI: -1.149 to -0.172, P=.008). Dexamethasone was associated with a lower opioid consumption at 12hours (SMD=-0.245, 95% CI: -0.465 to -0.025, P=.029), 24hours (SMD=-0.285, 95% CI: -0.505 to -0.064, P=.011), and 48hours (SMD=-0.989, 95% CI: -1.710 to -0.267, P=.007). Conclusion: Dexamethasone could significantly reduce postoperative pain scores and opioid consumption within the 1st 48hours following total joint arthroplasty (TJA). The overall evidence quality was moderate to low, further high-quality RCTs are needed to identify the optimal dose of dexamethasone for reducing pain after TJA.