Meta- analysis showed that high-dose systemic steroid ( dexamethasone > 0.1 mg/kg ) rather than low dose is effective to reduce postoperative nausea and vomiting and postoperative acute pain ( within 24 h ) .
In addition , systemic steroid is associated within faster functional rehabilitation and greater inflammation control .
On the other h and , systemic steroid is associated with a higher level of postoperative serum glucose on the operation day .
Conclusions Our study suggests that by providing lower incidence of postoperative nausea and vomiting and less postoperative acute pain , high-dose systemic steroid plays a critical role in rapid recovery to TKA and THA .
The preliminary results also show the superior possibility of systemic steroid in functional rehabilitation and inflammation control .
Background Perioperative systemic steroid administration for rapid recovery in total knee and hip arthroplasty ( TKA/THA ) is an important and controversial topic .
We conducted this systematic review and meta- analysis to evaluate the overall benefits and harms of perioperative systemic steroid in patients undergoing TKA and THA .
Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial.
BACKGROUND Total knee arthroplasty ( TKA ) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach , but the effect of high-dose glucocorticoid administration has not been studied . METHODS Forty-eight patients undergoing unilateral TKA were included in a r and omized , double-blind , placebo-controlled trial receiving preoperative methylprednisolone ( MP ) 125 mg i.v . or saline . All surgery was performed under lumbar spinal anaesthesia and patients received a st and ardized , multimodal analgesic regime . The primary endpoint was pain during walking 24 h after surgery , and secondary endpoints were pain at rest , pain upon hip flexion , and pain upon knee flexion . Pain assessment s were performed repeatedly for the first 48 h after surgery , in a question naire from days 2 to 10 , and at follow-up on days 21 and 30 . Tertiary endpoints were postoperative nausea and vomiting ( PONV ) , plasma C-reactive protein ( CRP ) concentrations , fatigue , sleep quality , and rescue analgesic and antiemetic requirements . RESULTS Pain during walking was significantly lower in the MP group up to 32 h after operation . Overall pain and cumulative pain scores ( 2 - 48 h ) were lower for all pain assessment s ( P<0.04 ) . Consumption of rescue oxycodone  was lower from 0 to 24 h ( P=0.02 ) and PONV , consumption of ondansetron  reduced ( P<0.05 ) , and CRP concentrations were lower at 24 h ( P<0.000001 ) . Fatigue throughout the day of surgery was lower ( P=0.02 ) , but sleep quality was worse on the first night ( P=0.002 ) . No side-effects or complications were observed in other respects . CONCLUSIONS MP 125 mg before surgery improves analgesia and immediate recovery after TKA , even when combined with a multimodal analgesic regime . These findings call for further studies on safety aspects
Meta- analysis showed that high-dose systemic steroid ( dexamethasone > 0.1 mg/kg ) rather than low dose is effective to reduce postoperative nausea and vomiting and postoperative acute pain ( within 24 h ) .
In addition , systemic steroid is associated within faster functional rehabilitation and greater inflammation control .
On the other h and , systemic steroid is associated with a higher level of postoperative serum glucose on the operation day .
Conclusions Our study suggests that by providing lower incidence of postoperative nausea and vomiting and less postoperative acute pain , high-dose systemic steroid plays a critical role in rapid recovery to TKA and THA .
The preliminary results also show the superior possibility of systemic steroid in functional rehabilitation and inflammation control .
Background Perioperative systemic steroid administration for rapid recovery in total knee and hip arthroplasty ( TKA/THA ) is an important and controversial topic .
We conducted this systematic review and meta- analysis to evaluate the overall benefits and harms of perioperative systemic steroid in patients undergoing TKA and THA .