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The efficacy and safety of preoperative glucocorticoids in herniorrhaphy: a systematic review and meta-analysis

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Abstract

Postoperative pain is the main reason for delayed recovery after herniorrhaphy. Preoperative glucocorticoid administration may improve postoperative recovery. The present study assessed the efficacy of preoperative glucocorticoids in facilitating recovery after herniorrhaphy. Randomized controlled trials (RCTs) conducted up to January 2021 were searched in electronic databases and trial registries. Meta-analyses were performed using random effects models. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of evidence. Seven RCTs (744 patients) were included in the meta-analysis. Preoperative glucocorticoid administration reduced patients’ pain on postoperative day 0 (standard mean difference [SMD] = − 0.73, 95% confidence interval [CI] − 1.45 to − 0.01; I2 = 94%). However, there was no marked difference in rescue analgesic use (risk ratio [RR] = − 0.06, 95% CI − 0.28 to − 0.16; I2 = 0%) or vomiting (RR = 0.78, 95% CI 0.50–1.20; I2 = 30%) between preoperative glucocorticoid administration and control. The certainty of evidence was moderate because of inconsistencies or imprecision. No serious adverse effects were observed. Preoperative glucocorticoid administration reduced pain in patients following herniorrhaphy without increasing the occurrence of adverse events. Further studies will be required to confirm the efficacy of preoperative glucocorticoids.

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Abbreviations

CI:

Confidence interval

NRS:

Numeric rating scale

PONV:

Postoperative nausea and vomiting

RCT:

Randomized controlled trials

RR:

Risk ratio

SMD:

Standard mean difference

VAS:

Visual analog scale

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Acknowledgements

We thank Dr. Toshihide Izumida and Ms. Chisato Fujiwara for providing us with the CENTRAL and ICTRP search data, respectively.

Funding

This research received no external funding.

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Authors and Affiliations

  1. Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan

    Jun Watanabe, Kazuma Rifu, Takehiro Kagaya & Naohiro Sata

  2. Division of Community and Family Medicine, Jichi Medical University, Shimotsuke City, Tochigi, Japan

    Jun Watanabe & Kazuhiko Kotani

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  1. Jun Watanabe
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  2. Kazuma Rifu
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  3. Takehiro Kagaya
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Correspondence to Jun Watanabe.

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Supplementary Information

Below is the link to the electronic supplementary material.

595_2021_2431_MOESM1_ESM.docx

Supplementary Supplementary 1: The electronic database search strategy. Supplementary 2: The trial registry search strategy. Supplementary 3: Risk of bias for the eligible studies (DOCX 22 KB)

595_2021_2431_MOESM2_ESM.pptx

Supplementary Supplementary Fig. 1: Forest plot of patients’ pain on postoperative day 0. A) Hernia types (inguinal vs. ventral incisional hernia), B) surgical approach (laparoscopy vs. open), and C) steroid types (dexamethasone vs. betamethasone vs. methylprednisolone). Supplementary Fig. 2: Forest plot of patients’ pain on postoperative day 1. A) Hernia types (inguinal vs. ventral incisional hernia), B) surgical approach (laparoscopy vs. open), and C) steroid types (dexamethasone vs. betamethasone vs. methylprednisolone) (PPTX 312 KB)

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Watanabe, J., Rifu, K., Kagaya, T. et al. The efficacy and safety of preoperative glucocorticoids in herniorrhaphy: a systematic review and meta-analysis. Surg Today 52, 1237–1245 (2022). https://doi.org/10.1007/s00595-021-02431-1

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  • DOI: https://doi.org/10.1007/s00595-021-02431-1

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