Objective  To systematically review the efficacy of multiple doses and single dose of perioperative dexamethasone on pain and recovery after total knee arthroplasty (TKA).

Methods  PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, SinoMed and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on multiple doses and single dose of dexamethasone during perioperative period of TKA from inception of the databases to January 4, 2024. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was performed by using RevMan 5.4 software.

Results  A total of 6 studies involving 674 patients were included, 336 patients in single dose dexamethasone group and 338 patients in multiple dose dexamethasone group. The results of Meta-analysis showed that compared with single dose of dexamethasone, multiple doses of perioperative dexamethasone could significantly decrease the pain scores at rest at 48 h after TKA (SMD=-0.68, 95%CI -1.05 to -0.30, P﹤0.001), the pain scores with movement at postoperative 48 h (SMD= -0.86, 95%CI -1.37 to  -0.34, P=0.001), C-reactive protein (CRP) levels at postoperative 48  h (MD=- 4.43, 95%CI  -6.70 to  -2.16, P ﹤ 0.001) and CRP levels at postoperative 72 h (MD= -3.60, 95%CI -5.53 to -1.67, P ﹤ 0.001). There was no statistically significant difference between the two groups regarding pain scores at rest at postoperative 24 h and 72 h, pain scores with movement at postoperative 24 h and 72  h, incidence of postoperative nausea and vomiting (PONV), CRP levels at postoperative 24 h, length of hospital stay, and incidence of adverse drug reactions (P>0.05). The results of 5 studies showed that multiple doses of dexamethasone did not increase the dosage or patient proportion of remedial analgesics.

Conclusion  Current evidence shows that compared with single dose of dexamethasone, multiple doses of perioperative dexamethasone can significantly reduce pain scores at postoperative 48 h, CRP levels at postoperative 48 and 72 h after TKA, but it does not significantly reduce the incidence of PONV, hospital stay, or increase the risk of adverse drug reactions.

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