Perioperative adjuvant corticosteroids for postoperative analgesia in knee arthroplasty

Traditionally, pain control following surgery heavily depends on the use of systemic opiates, which were associated with multiple side effects. Thus, the present review suggested that 50-75 mg prednisolone significantly reduce pain postoperatively at 12 and 24 hours.

To discover the safety and efficacy of perioperative adjuvant corticosteroids during knee arthroplasty. 

Embase, Central, and Medline databases were searched and selected the randomized studies involved examination of the analgesic impact of adjuvant perioperative corticosteroids during knee arthroplasty. Postoperative pain score at 24 hours was considered as the primary outcome and pain at 12, 48, and 72 hours, infection, discharge time, postoperative nausea and vomiting, and opiate consumption were as the secondary endpoints. Local and systemic corticosteroids were examined independently. 

A total of 14 randomized controlled trials comprising 1,396 knees were selected for the analysis. Both local and systemic routes showed equivalent mean corticosteroid dosages (50-75mg oral Prednisolone). Systemic corticosteroids displayed statistically notable and clinically moderate declines in pain at 12, 24 hours and 48 hours whereas local corticosteroids did not lessen the pain. Both groups exhibited similar postoperative nausea and vomiting, time until discharge, infection, and opiate consumption. 

Corticosteroids moderately lessen pain postoperatively at 12 and 24 hours when utilised systemically without any addition in related risks for dosages between 50 and 75 mg oral Prednisolone equivalents.