Adding corticosteroids to periarticular infiltration analgesia improves the short-term analgesic effects after total knee arthroplasty: a prospective, double-blind, randomized controlled trial

Abstract

PurposePeriarticular infiltration analgesia (PIA) is widely used to control postoperative pain in patients who underwent total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of adding corticosteroids to the PIA cocktail for pain management in patients who underwent TKA. MethodsThe patients were randomized to the corticosteroid or control group (double‐blind). The patients in the corticosteroid group received a periarticular infiltration of an analgesic cocktail of ropivacaine, epinephrine, and dexamethasone. Dexamethasone was omitted from the cocktail in the control group. The primary outcomes were postoperative pain [assessed using a visual analog scale (VAS)], time until the administration of first rescue analgesia, morphine consumption, and postoperative inflammatory biomarkers [C‐reactive protein (CRP) and interleukin‐6 (IL‐6)]. The secondary outcomes were functional recovery, assessed by the range of knee motion, quadriceps strength, and daily ambulation distance. The tertiary outcomes included postoperative adverse effects. ResultsThe patients in the corticosteroid group had significantly lower resting VAS scores at 6 and 12 h after surgery, lower VAS scores during motion up to 24 h after surgery, and lower levels of inflammatory biomarkers. All the differences in the VAS scores between the two groups did not reach the point to be considered clinically significant. The additional use of corticosteroid significantly prolonged analgesic effects and led to lower rescue morphine consumption. The patients in the corticosteroid group had significantly better functional recovery on the first day after surgery. The two groups had a similar occurrence of adverse effects. ConclusionsAdding corticosteroids to an analgesic cocktail for PIA could lightly improve early pain relief and accelerate recovery in the first 24 h after TKA. Level of evidenceRandomized controlled trial, Level I.

Efficacy of additional corticosteroids to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis of randomized controlled trials

“…There is a close relationship between postoperative pain and inflammatory response [36]. Some studies have shown that corticosteroids can alleviate pain by inhibiting inflammatory response [19,37]. However, due to the lack of relevant studies, this meta-analysis did not make detailed statistics on inflammatory indicators such as C-reactive protein, erythrocyte sedimentation rate, and IL-6.…”

“…After reading the title and abstract, 199 articles were eliminated, leaving 72. Sixty-two articles were discarded for various reasons (retrospective study, review article, unicondylar knee arthroplasty, case report, intravenous injection, and expert consensus or guide) when the full text was browsed for further screening, and 10 studies [11,12,14,19,20,[22][23][24][25][26] finally met the inclusion criteria (Fig. 1, flow chart of study selection).…”

“…In order to solve this problem, this meta-analysis, by analyzing the current RCTs involving periarticular injection only, aims to clarify whether periarticular injection including corticosteroids can relieve postoperative pain and improve knee joint function in different time points, and explore its safety. In addition, two recent RCTs [19,20] were included in this study to obtain a higher quality result.…”

Efficacy of Additional Corticosteroids to Multimodal Cocktail Periarticular Injection in Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

“…There is a close relationship between postoperative pain and in ammatory response [36]. Some studies have shown that corticosteroids can alleviate pain by inhibiting in ammatory response [20,37]. However, due to the lack of relevant studies, this meta-analysis did not make detailed statistics on in ammatory indicators such as C-reactive protein, erythrocyte sedimentation rate, IL-6.…”

“…After reading the title and abstract, 199 articles were eliminated, leaving 72. 62 articles were discarded for various reasons(retrospective study, review article, unicondylar knee arthroplasty, case report, intravenous injection and expert consensus or guide) when the full text was browsed for further screening, and 10 studies [11,12,14,[20][21][22][23][24][25][26] nally met the inclusion criteria( Figure. 1 Flow chart of study selection). The characteristics of the 10 studies involved 829 participants were summarized in Table. 1 Characteristics of the included studies.…”