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Current Pain and Headache Reports
Published in: Current Pain and Headache Reports 11/2016

01-11-2016 | Other Pain (N Vadivelu and A Kaye, Section Editors)

NSAIDs in the Treatment of Postoperative Pain

Authors: Anita Gupta, Maimouna Bah

Published in: Current Pain and Headache Reports | Issue 11/2016

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Abstract

Purpose of Review

Postoperative pain results in multiple undesirable physiologic and psychological outcomes, and it should be managed in a multimodal approach. This article reviews the latest scientific literature of NSAIDs in the treatment of postoperative pain. The goal is to answer the following questions: (1) Are NSAIDs effective in the postoperative period? (2) Are NSAIDs safe in all surgical patients? and (3) Are adverse effects of NSAIDs increased or diminished in the acute postoperative period?

Recent Findings

NSAIDs are safe and effective in the treatment of postoperative pain, and they should be administered to all postoperative surgical patients unless contraindicated.

Summary

Based on literature, NSAIDs have been shown to increase patient satisfaction and decrease opioid requirements, minimizing opiate-induced adverse events. They have no increased incidence of adverse effects during the acute postoperative period. NSAIDs and COX-2 inhibitors, however, should be used with caution in colorectal surgery as they are proven to increase the risk of anastomotic leak.
Literature
1.
American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116(2):248–73.CrossRef
2.
Stasiowska MK et al. Postoperative pain management. Br J Hosp Med (Lond). 2015;76(10):570–5.CrossRef
3.
4.
IRF Institute for Healthcare Informatics. The use of medicines in the United States: review of 2010. Parsippany, NJ: IRF Institute for Healthcare Informatics; 2011
5.••
Nir, R.-R., Nahman-Averbuch, H., Moont, R., Sprecher, E., Yarnitsky, D.. Preoperative preemptive drug administration for acute postoperative pain: A systematic review and meta-analysis. Eur J Pain. 2016; doi:10.​1002/​ejp.​842. Demonstrated a significant reduction in postoperative analgesic consumption with use of preoperative administration of non-steroidal anti-inflammatory.
6.
Southworth S et al. A multicenter, randomized, double-blind, placebo-controlled trial of intravenous ibuprofen 400 and 800 mg every 6 h in the management of postoperative pain. Clin Ther. 2009;31(9):1922–35.CrossRefPubMed
7.
Gritsenko K, Khelemsky Y, Kaye AD, Vadivelu N, Urman RD. Multimodal therapy in perioperative analgesia. Best Pract Res Clin Anaesthesiol. 2014;28(1):59–79.CrossRefPubMed
8.
Mathiesen O, Wetterslev J, Kontinen VK, et al. Adverse effects of perioperative paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations: a topical review. Acta Anaesthesiol Scand. 2014;58(10):1182–98.CrossRefPubMed
9.
Rana MV, Desai R, Tran L, Davis D. Perioperative pain control in the ambulatory setting. Curr Pain Headache Rep. 2016;20(3):18.CrossRefPubMed
10.
Viscusi ER, Frenkl TL, Hartrick CT, et al. Perioperative use of etoricoxib reduces pain and opioid side-effects after total abdominal hysterectomy: a double-blind, randomized, placebo controlled phase III study. Curr Med Res Opin. 2012;28:1323–35.CrossRefPubMed
11.
Buvanendran A, Kroin JS, Tuman KJ, Lubenow TR, Elmofty D, Moric M, et al. Effects of perioperative administration of a selective cyclooxygenase 2 inhibitor on pain management and recovery of function after knee replacement: a randomized controlled trial. JAMA. 2003;290:2411–8.CrossRefPubMed
12.
Takada M, Fukusaki M, Terao Y, Yamashita K, Inadomi C, Takada M, et al. Preadministration of flurbiprofen suppresses prostaglandin production and postoperative pain in orthopedic patients undergoing tourniquet inflation. J Clin Anesth. 2007;19:97–100.CrossRefPubMed
13.
Takada M, Fukusaki M, Terao Y, Yamashita K, Takada M, Ando Y, et al. Postoperative analgesic effect of preoperative intravenous flurbiprofen in arthroscopic rotator cuff repair. J Anesth. 2009;23:500–3.CrossRefPubMed
14.
Rivkin A, Rivkin MA. Perioperative nonopioid agents for pain control in spinal surgery. Am J Health Syst Pharm. 2014;71(21):1845–57.CrossRefPubMed
15.
Srivastava S, Gupta D, Naz A, Rizvi MM, Singh PK. Effects of preoperative single dose Etoricoxib on postoperative pain and sleep after lumbar diskectomy: prospective randomized double blind controlled study. Middle East J Anaesthesiol. 2012;21:725–30.PubMed
16.
Michelet, Daphne, Andreu-Gallien, Juliette, MD, PhD, et al. A meta-analysis of the use of nonsteroidal antiinflammatory drugs for pediatric postoperative pain. Anesth Analg. 2012;114(2):393–406.
17.
De Baerdemaeker L, Margarson M. Best anaesthetic drug strategy for morbidly obese patients. Curr Opin Anaesthesiol. 2016;29(1):119–28.CrossRefPubMed
18.
Pogatzki-Zahn E, Chandrasena C, Schug S. Nonopioid analgesics for postoperative pain management. Curr Opin Anaesthesiol. 2014;27(5):513–9.CrossRefPubMed
19.
Nonaka T, Hara M, Miyamoto C, Sugita M, Yamamoto T. Comparison of the analgesic effect of intravenous acetaminophen with that of flurbiprofen axetil on post-breast surgery pain: a randomized controlled trial. J ANESTH. 2016;30(3):405–9.CrossRefPubMed
20.
Beaussier M, Weickmans H, Paugam C, Lavazais S, Baechle JP, Goater P, et al. A randomized, double-blind comparison between parecoxib sodium and propacetamol for parenteral postoperative analgesia after inguinal hernia repair in adult patients. Anesth Analg. 2005;100:1309–15.CrossRefPubMed
21.
Kesimci E, Gümüş T, Izdeş S, Sen P, Kanbak O. Comparison of efficacy of dexketoprofen versus paracetamol on postoperative pain and morphine consumption in laminectomy patients. Agri. 2011;23:153–9.CrossRefPubMed
22.
Jung YS et al. Onset of analgesia and analgesic efficacy of tramadol/acetaminophen and codeine/acetaminophen/ibuprofen in acute postoperative pain: a single-center, single-dose, randomized, active-controlled, parallel-group study in a dental surgery pain model. Clin Ther. 2004;26(7):1037–45.CrossRefPubMed
23.
Cooper SA, Reynolds DC, Gallegos LT, Reynolds B, Larouche S, Demetriades J, et al. A PK/PD study of ibuprofen formulations. Clin Pharmacol Ther. 1994;55:126.
24.
Olson NZ, Otero AM, Marrero I, Tirado S, Cooper S, Doyle G, et al. Onset of analgesia for liquigel ibuprofen 400 mg, acetaminophen 1000 mg, ketoprofen 25 mg, and placebo in the treatment of postoperative dental pain. J Clin Pharmacol. 2001;41:1238–47.CrossRefPubMed
25.
26.
Derry, P., et al., Single dose oral diclofenac for acute postoperative pain in adults. Cochrane Database Syst Rev, 2015(2): p. CD004768.
27.
Low dose diclofenac (Zorvolex) for pain. Med Lett Drugs Ther, 2014. 56 (1437): p. 19–20.
28.
29.
Argoff, C., et al. SoluMatrix(R) Diclofenac: sustained opioid-sparing effects in a phase 3 study in patients with postoperative pain. Pain Med. 2016. doi:10.​1093/​pm/​pnw012.
30.
Lloyd R, Derry S, Moore RA, McQuay HJ. Intravenous or intramuscular parecoxib for acute postoperative pain in adults. Cochrane Database Syst Rev 2009; CD004771.
31.
Smirnov G, Tera ̈Va M, Tuomilehto H, et al. Etoricoxib for pain management during thyroid surgery: a prospective, placebo-controlled study. Otolaryngol Head Neck Surg. 2008;138:92–7.CrossRefPubMed
32.
Rawal N, Viscusi E, Peloso PM, et al. Evaluation of etoricoxib in patients undergoing total knee replacement surgery in a double-blind, randomized controlled trial. BMC Musculoskelet Disord. 2013;14:300.CrossRefPubMedPubMedCentral
33.
Daniels SE, Bandy DP, Christensen SE, et al. Evaluation of the dose range of etoricoxib in an acute pain setting using the postoperative dental pain model. Clin J Pain. 2011;27:1–8.CrossRefPubMed
34.
Hillstrom C, Jakobsson JG. Lornoxicam : pharmacology and usefulness to treat acute postoperative and musculoskeletal pain a narrative review. Expert Opin Pharmacother. 2013;14(12):1679–94.CrossRefPubMed
35.
Mowafi HA, Telmessani L, Ismail SA, Naguib MB. Preoperative lornoxicam for pain prevention after tonsillectomy in adults. J Clin Anesth. 2011;23:97–101.CrossRefPubMed
36.
Inan N, Ozcan N, Takmaz SA, Ozcan A, Erdog ̆an I, Baltaci B. Efficacy of lornoxicam in postoperative analgesia after total knee replacement surgery. Agri. 2007;19:38–45.PubMed
37.
Kurukahvecioglu O et al. Effect of meloxicam on postoperative pain relief after inguinal hernia repair with local anaesthesia. West Indian Med J. 2007;56(6):530–3.PubMed
38.
Aghadavoudi O et al. Comparison of pre-emptive effect of meloxicam and celecoxcib on post-operative analgesia: a double-blind, randomized clinical trial. Middle East J Anaesthesiol. 2015;23(3):289–94.PubMed
39.
Chang WK, Wu HL, Yang CS, et al. Effect on pain relief and inflammatory response following addition of tenoxicam to intravenous patient-controlled morphine analgesia: a double-blind, randomized, controlled study in patients undergoing spine fusion surgery. Pain Med. 2013;14:736–48.CrossRefPubMed
40.
Southworth SR et al. An integrated safety analysis of intravenous ibuprofen (Caldolor((R)) in adults. J Pain Res. 2015;8:753–65.PubMedPubMedCentral
41.
Mathiesen O, Dahl B, Thomsen BA, et al. A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery. Eur Spine J. 2013;22(9):2089–96.CrossRefPubMedPubMedCentral
42.
Aveline C, Gautier JF, Vautier P, et al. Postoperative analgesia and early rehabilitation after total knee replacement: a comparison of continuous low- dose intravenous ketamine versus nefopam. Eur J Pain. 2009;13:613–9.CrossRefPubMed
43.
Schjerning Olsen AM, Fosbol EL, Lindhardsen J, et al. Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study. Circulation. 2011;123:2226–35.CrossRefPubMed
44.
45.•
Gan TJ et al. Cardiovascular safety of hydroxypropyl-beta-cyclodextrin-diclofenac in the management of acute postsurgical pain: a pooled analysis of 2 randomized, double-blind, placebo- and active comparator-controlled phase III clinical trials. J Clin Anesth. 2016;31:249–58. In depth randomized trial that found IV HPβCD-diclofenac to be safe and effective with no increased cardiovascular incidence in postoperative patients.
46.
Schug S, Joshi GP, Camu F, et al. Cardiovascular safety of the cyclooxygenase-2 selective inhibitors parecoxib and valdecoxib in the postoperative setting: an analysis of integrated data. Anesth Analg. 2009;108:299–307.CrossRefPubMed
47.
Holte K, Andersen J, Jakobsen DH, Kehlet H. Cyclo- oxygenase 2 inhibitors and the risk of anastomotic leakage after fast-track colonic surgery. Br J Surg. 2009;96:650–4.CrossRefPubMed
48.
Rosenberg J, Harvald T. Severe complications with diclofenac after colonic resection. Dis Colon Rectum. 2007;50:685.CrossRefPubMed
49.
Klein M, Andersen LP, Harvald T, Rosenberg J, Gogenur I. Increased risk of anastomotic leakage with diclofenac treatment after laparoscopic colorectal surgery. Dig Surg. 2009;26:27–30.CrossRefPubMed
50.••
Klein M, Gogenur I, Rosenberg J. Postoperative use of non-steroidal anti-inflammatory drugs in patients with anastomotic leakage requiring reoperation after colorectal resection: cohort study based on prospective data. BMJ. 2012;345:e6166. This study found that diclofenac treatment resulted in an increased proportion of patients with anastomotic leakage after colorectal surgery and recommend COX-2 to be used with caution.
51.••
Kelley B, Bennett K, Chung K, Kozlow J. Ibuprofen may not increase bleeding risk in plastic surgery: a systematic review and meta-analysis. Plast Reconstr Surg. 2016;137(4):1309–16. This article demonstrated that ibuprofen provides equivalent pain control to narcotics in postoperative pain management. There were no increased risks of bleeding.
52.
Gobble RM, Hoang HL, Kachniarz B, Orgill DP. Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials. Plast Reconstr Surg. 2014;133:741–55.CrossRefPubMed
53.
Huang YM, Wang CM, Wang CT, Lin WP, Horng LC, Jiang CC. Perioperative celecoxib administration for pain management after total knee arthroplasty—a randomized, controlled study. BMC Musculoskelet Disord. 2008;9:77.CrossRefPubMedPubMedCentral
54.
Schug SA, Manopas A. Update on the role of non-opioids for postoperative pain treatment. Best Pract Clin Anaesthesiol. 2007;21(1):15–30.CrossRef
55.
Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am. 2011;93-A(11):1075–84.CrossRef
56.
Straube S, Derry S, Mcquay HJ, Moore RA. Effect of preoperative Cox-II-selective NSAIDs (coxibs) on postoperative outcomes: a systematic review of randomized studies. Act a Anaesthesiol Scand. 2005;49:601–13.CrossRef
57.
Abdul-Hadi O, Parvizi J, Austin MS, Viscusi E, Einhorn T. Nonsteroidal anti- inflammatory drugs in orthopaedics. J Bone Joint Surg Am. 2009;91:2020–7.PubMed
58.
Kurmis AP, Kurmis TP, O’Brien JX, Dalen T. The effect of nonsteroidal anti-inflammatory drug administration on acute phase fracture-healing: a review. J Bone Joint Surg Am. 2012;94:815–23.CrossRefPubMed
59.
Joshi GP et al. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery. Br J Surg. 2012;99(2):168–85.CrossRefPubMed
60.
McCormack PL, Scott LJ. Diclofenac sodium injection (Dyloject): in postoperative pain. Drugs. 2008;68(1):123–30.CrossRefPubMed
61.
Coxib and traditional NSAID Trialists’ (CNT) Collaboration, Bhala N, Emberson J, Merhi A, et al. Vascular and upper gastrointestinal effects of nonsteroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382:769–79.CrossRef
Metadata
Title
NSAIDs in the Treatment of Postoperative Pain
Authors
Anita Gupta
Maimouna Bah
Publication date
01-11-2016
Publisher
Springer US
Published in
Current Pain and Headache Reports / Issue 11/2016
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-016-0591-7