目的:通过meta分析评价术前单次高剂量静脉滴注甲泼尼龙(MP)在全关节置换术后疼痛管理中的有效性和安全性.方法:检索Pubmed、Embase、Cochrane Library、Web of Science共4个数据库中关于全关节置换术前单次高剂量静脉滴注MP的随机对照试验(RCT)研究,时间范围为从建库开始至2023年12月.运用RevMan 5.3软件进行meta分析.结果:共检索到文献904篇,筛选后最终纳入8篇文献进行meta分析,共包括583例患者.分析结果显示:MP组患者术后6 h疼痛视觉模拟(VAS)评分及术后24 h静息状态VAS评分均显著低于对照组患者[术后6 h:平均差(MD)=-2.66,95%置信区间(95%CI):-4.63～-0.69,P=0.008;术后24 h静息状态:MD=-0.91,95%CI:-1.56～-0.25,P=0.006],术后24 h、48 h VAS评分与对照组患者相比差异均无统计学意义(术后24 h:MD=-0.40,95%CI:-2.34～1.54,P=0.680;术后48 h:MD=-0.46,95%CI:-1.40～0.48,P=0.340);MP组患者术后阿片类药物使用率显著低于对照组患者(OR=0.12,95%CI:0.03～0.43,P=0.001);MP组患者术后恶心发生率显著低于对照组患者[比值比(OR)=0.08,95%CI:0.01～0.43,P=0.004],术后24 h、48 h呕吐发生率均低于对照组患者,且术后48 h呕吐发生率差异有统计学意义(术后24 h:OR=0.58,95%CI:0.18～1.93,P=0.370;术后48 h:OR=0.13,95%CI:0.02～0.78,P=0.030);MP组患者昂丹司琼使用率也显著低于对照组患者(OR=0.18,95%CI:0.05～0.61,P=0.006);MP组患者住院时间显著短于对照组患者(MD=-1.01,95%CI:-1.99～-0.03,P=0.040);MP组患者术后0 h、24 h、48 h、72 h C反应蛋白(CRP)水平均显著低于对照组患者(术后0 h:MD=-15.08,95%CI:-27.83～-2.32,P=0.020;术后24 h:MD=-22.13,95%CI:-32.77～-11.50,P＜0.001;术后48 h:MD=-59.25,95%CI:-78.44～-40.05,P＜0.001;术后72 h:MD=-53.70,95%CI:-77.33～-30.07,P＜0.001).MP组与对照组患者术后并发症发生率差异无统计学意义(OR=0.59,95%CI:0.08～4.61,P=0.610).结论:术前单次高剂量静脉滴注MP可以有效减轻全关节置换术后疼痛,减少术后恶心呕吐和阿片类药物的使用,缩短患者住院时间,并有良好的抗炎效果和安全性,但仍需更多高质量的RCT研究进一步验证.
Efficacy and safety of preoperative intravenous methylprednisolone administration for pain management after total joint replacement:a meta-analysis
Objective:To evaluate the efficacy and safety of preoperative single high-dose intravenous methylprednisolone(MP)for pain management in total joint arthroplasty(TJA).Methods:The Pubmed,Embase,Cochrane Library,and Web of Science databases were searched for randomized controlled trials(RCTs)involving a single intravenous dose of MP before TJA,from the inception of the database to December 2023.The meta-analysis was performed using RevMan 5.3 software.Results:A total of 904 articles were retrieved,and 8 articles involving 583 patients were finally included in the meta-analysis after screening.The analysis results showed that the postoperative 6-hour visual analogue scale(VAS)scores and the 24-hour resting VAS scores in the MP group were significantly lower than those in the control group(postoperative 6 hours:mean difference[MD]=-2.66,95%confidence interval[95%CI],-4.63 to-0.69,P=0.008;24-hour resting:MD=-0.91,95%CI,-1.56 to-0.25,P=0.006).There was no statistically significant difference in the control group in the VAS socres at 24 hours or 48 hours postoperatively(24 hours:MD=-0.40,95%CI,-2.34 to 1.54,P=0.680;48 hours:MD=-0.46,95%CI,-1.40 to 0.48,P=0.340).The opioid use rate in the MP group was significantly lower than that in the control group(OR=0.12,95%CI,0.03 to 0.43,P=0.001);the incidence of postoperative nausea in the MP group was significantly lower than that in the control group(OR=0.08,95%CI,0.01 to 0.43,P=0.004),the incidence of vomiting was statistically lower than that of the control group at 24 hours and 48 hours postoperatively and was significantly lower at 48 hours postoperatively(24 hours:OR=0.58,95%CI,0.18 to 1.93,P=0.370;48 hours:OR=0.13,95%CI,0.02 to 0.78,P=0.030);the postoperative ondansetron usage rate in the MP group was also significantly lower than that in the control group(OR=0.18,95%CI,0.05 to 0.61,P=0.006);hospital stay in the MP group was significantly shorter than that in the control group(MD=-1.01,95%CI,-1.99 to-0.03,P=0.040);and the C-reactive protein levels of patients in the MP group were significantly lower than those in the control group at 0,24,48,and 72 hours after surgery(0 hour:MD=-15.08,95%CI,-27.83 to-2.32,P=0.020;24 hours:MD=-22.13,95%CI,-32.77 to-11.50,P<0.001;48 hours:MD=-59.25,95%CI,-78.44 to-40.05,P<0.001;72 hours:MD=-53.70,95%CI,-77.33 to-30.07,P<0.001).There was no statistically significant difference in the incidence of adverse events between the MP and control groups(OR=0.59,95%CI,0.08 to 4.61,P=0.610).Conclusions:Preoperative single high-dose intravenous MP is effective in reducing postoperative pain,postoperative nausea and vomiting,and opioid use,shortening patient hospitalizationas,as well as having a favorable anti-inflammatory effect and safety profile,but more high-quality RCTs are needed for further validation.
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