In this article, we review controversies in assessing the risk of serious adverse effects caused by administration of nonsteroidal anti-inflammatory drugs (NSAIDs). Our focus is upon NSAIDs used in short courses for the management of acute postoperative pain. In our review of the literature, we found that the risks of short-term NSAID use may be overemphasized. Specifically, that the likelihood of renal dysfunction, bleeding, nonunion of bone, gastric complications, and finally, cardiac dysfunction do not appear to be significantly increased when NSAIDs are used appropriately after surgery. The importance of this finding is that in light of the opioid epidemic, it is crucial to be aware of alternative analgesic options that are safe for postoperative pain control.
GuptaABahM. NSAIDs in the treatment of postoperative pain. Curr Pain Headache Rep. 2016;20(11):62.
2.
AdesoyeADuncanN. Acute pain management in patients with opioid tolerance. US Pharm. 2017;42(3):28-32.
3.
SchollLSethPKariisaM, et al.Drug and opioid-involved overdose deaths–United States, 2013-2017. Morb Mortal Wkly Rep. 2019;67(5152):1419-1427.
4.
LadhaKSNeumanMDBromsG, et al.Opioid prescribing after surgery in the United States, Canada, and Sweden. JAMA Network Open. 2019;2(9):e1910734.
5.
BethellCWaljeeJGoeslingJ, et al.New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152(6):e170504.
6.
ManchikantiLHelmSFellowsB, et al.Opioid epidemic in the United States. Pain Physician. 2012;15:ES9-ES38.
7.
FlorenceCSZhouCLuoFXuLZhouC. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Medical Care. 2016;54(10):901-906.
8.
MaundEMcDaidCRiceSWrightKJenkinsBWoolacottN. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: A systematic review. Br J Anaesth. 2011;106(3):292–297.
9.
WrightZXuHZhangY, et al.Nonsteroidal anti-inflammatory drugs for postoperative pain control after lumbar spine surgery: A meta-analysis of randomized controlled trials. J Clin Anesth. 43;2017:84-89.
10.
LiEAMarshallJGSelphSSBarkerDRSedgleyCM. Nonsteroidal anti-inflammatory drugs for managing postoperative endodontic pain in patients who present with preoperative pain: A systematic review and meta-analysis. J Endod. 2017;43(1):7-15.
11.
ChapmanSJGarnerJJDrakeTMAldaffaaMJayneDG. Systematic review and meta-analysis of nonsteroidal anti-inflammatory drugs to improve GI recovery after colorectal surgery. Dis Colon Rectum. 2019;62:248-256.
12.
MartinezAGRodriguezBERocaAP, et al.Intravenous ibuprofen for treatment of post-operative pain: A multicenter, double blind, placebo-controlled, randomized clinical trial. PloS One. 11(5): e0154004.
13.
ChangAKBijurPEEssesDBarnabyDPBaerJ. Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department. J Am Med Assoc. 2017;318(17):1661-1667.
14.
KrebsEEGravelyANugentS, et al.Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: The SPACE randomized clinical. J Am Med Assoc. 2018;319(9):872-882.
15.
WhitePFJoshiGPCarpenterRLFragenRJ. A comparison of oral ketorolac and hydrocodone-acetaminophen for analgesia after ambulatory surgery. Anesth Analg. 1997;85(1):37-43.
16.
SinglaNPongANewmanK. Combination oxycodone 5 mg/ibuprofen 400 mg for thetreatment of pain after abdominal or pelvic surgery in women: A randomized, double-blind, placebo- and active-controlled parallel-group study. Clin Therapeut. 2005;27(1):45-57.
17.
MitchellAVan zantenSVInglisKPorterG. A randomized controlled trial comparing acetaminophen plus ibuprofen versus acetaminophen plus codeine plus caffeine after outpatient general surgery. J Am Coll Surg. 2008;206(3):472-479.
18.
KrollPBMeadowsLRockAPavlivL. A multicenter, randomized, double-blind, placebo-controlled trial of intravenous ibuprofen (IV-ibuprofen) in the management of postoperative pain following abdominal hysterectomy. Pain Pract. 2011;11(1):23-32.
19.
ThyboKHHägi-PedersenDDahlJB, et al.Effect of combination of paracetamol (acetaminophen) and ibuprofen vs either alone on patient-controlled morphine consumption in the first 24 hours after total hip arthroplasty. J Am Med Assoc. 2019;321(6):562-571.
20.
AhiskaliogluEOAhiskaliogluAAydinPYayikAMTemizA. Effects of single-dose preemptive intravenous ibuprofen on postoperative opioid consumption and acute pain after laparoscopic cholecystectomy. Medicine (Baltim). 2017;96(8):e6200.
21.
SimVHawkinsSGaveAA, et al.How low can you go: Achieving postoperative outpatient pain control without opioids. Journal of Trauma and Acute Care Surgery. 2019;87(1):100-103.
22.
DavisARobsonJ. The dangers of NSAIDs: Look both ways. Br J Gen Pract. 2016;66(645):172-173.
23.
ForsytheMBogdanichW. McKinsey advised purdue pharma how to ‘turbocharge’ opioid sales lawsuit says. The New York Times. February 1,2019. Section B, Page 4.
24.
ChouRGordonDBde Leon-CasasolaOA, et al.Management of postoperative pain: A clinical practice guideline from the american pain society, the american society of regional anesthesia and pain medicine, and the american society of anesthesiologists committee on regional anesthesia, executive committee, and administrative council. J Pain. 2016;17(2):131-157.
25.
ParkJT. Postoperative acute kidney injury. Korean Journal of Anesthesiology. 2017;70(3):258-266.
26.
ChertowGMLevyEMHammermeisterKEGroverFDaleyJ. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med. 1998;104(4):343-348.
27.
LeeACooperMCCraigJCKnightJFKeneallyJP. Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function. Cochrane Database Syst Rev. 2004;(2):CD002765.
28.
FeldmanHIKinmanJBerlinJ, et al.Parenteral ketorolac: The risk for acute renal failure. Ann Intern Med. 1997;126(3):193-199.
29.
ChangY-KLiuJ-SHsuY-HTarngD-CHsuC-C. Increased risk of end-stage renal disease (ESRD) requiring chronic dialysis is associated With use of nonsteroidal anti-inflammatory drugs (NSAIDs). Medicine. 2015;94(38):e1362.
30.
BouckZMecredyGCIversNM, et al.Frequency and associations of prescription nonsteroidal anti-inflammatory drug use among patients with a musculoskeletal disorder and hypertension, heart failure, or chronic kidney disease. JAMA Internal Medicine. 2018;178(11):1516-1525.
31.
GobbleRMHoangHLTKachniarzBOrgillDP. Ketorolac does not increase perioperative bleeding. Plast Reconstr Surg. 2014;133(3):741-755.
32.
KellyBPBennettKGChungKCKozlowJH. Ibuprofen may not increase bleeding risk in plastic surgery. Plast Reconstr Surg. 2016;137(4):1309-1316.
33.
KozlowTRPhelanRDavidsonJSTurnerKE. Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty. Can Med Assoc J. 2012;59(5):466-472.
34.
FragenRJStulbergSDWixsonRGlissonSLibrojoE. Effect of ketorolac tromethamine on bleeding and on requirements for analgesia after total knee arthroplasty. J Bone Joint Surg. 1995;77(7):998-1002.
35.
SlappendelRWeberEWGBenraadBDirksenRBugterMLT. Does ibuprofen increase perioperative blood loss during hip arthroplasty?. Eur J Anaesthesiol. 2002;19(11):829-831.
36.
SpiroASTimo BeilFBaranowskyA, et al.BMP-7-induced ectopic bone formation and fracture healing is impaired by systemic NSAID application in C57BL/6-mice. J Orthop Res. 2010;28:785.
JeffcoachDRSamsVGLawsonCM, et al.Nonsteroidal anti-inflammatory drugs' impact on nonunion and infection rates in long-bone fractures. J Trauma Acute Care Surg. 2014;76(3):779-783.
39.
SoreideEGrananL-PHjorthaugGAEspehaugBDimmenSNordslettenL. The effect of limited perioperative nonsteroidal anti-inflammatory drugs on patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44(12):3111-3118.
40.
FaderLWhitakerJLopezM, et al.Tibia fractures and NSAIDs. Does it make a difference? A multicenter retrospective study. Injury. 2018;49(12):2290-2294.
41.
OhJHSeoHJLeeY-HChoiH-YJoungHYKimSH. Do selective COX-2 inhibitors affect pain control and healing after arthroscopic rotator cuff repair? A preliminary study. Am J Sports Med. 2018;46(3):679-686.
42.
Marquez-LaraAHutchinsonIDNuñezFSmithTLMillerAN. Nonsteroidal anti-inflammatory drugs and bone-healing. JBJS Reviews. 2016;4(3):01874474.
43.
YuZCrichtonITangSY, et al.Disruption of the 5-lipoxygenase pathway attenuates atherogenesis consequent to COX-2 deletion in mice. Proc Natl Acad Sci Unit States Am. 2012;109(17):6727-6732.
44.
BresalierRSSandlerRSQuanH, et al.Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med. 2005;352:1092-1102.
45.
SibbaldB. Rofecoxib (Vioxx) voluntarily withdrawn from market. Can Med Assoc J. 2004;171(9):1027-1028.
46.
BhalaNBhalaNEmbersonJ, et al.Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: Meta-analyses of individual participant data from randomised trials. Lancet. 2013;382:769-779.
47.
AngiolilloDJWeismanSM. Clinical pharmacology and cardiovascular safety of naproxen. Am J Cardiovasc Drugs. 2017;17(2):97-107.
GanTJSinglaNDanielsSE, et al.Cardiovascular safety of hydroxypropyl-β-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;31:249-258.
50.
HynninenMSChengDCHHossainI, et al.Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery. Can J of Anesth. 2000;47(12):1182-1187.
51.
KulikARuelMBourkeM, et al.Postoperative naproxen after coronary artery bypass surgery: A double-blind randomized controlled trial. Eur J Cardio Thorac Surg. 2004;26(4):694-700.
52.
De Souza BritoFMehtaRHLopesRD, et al.Nonsteroidal anti-inflammatory drugs and clinical outcomes in patients undergoing coronary artery bypass surgery. Am J Med. 2017;130(4):462-468.
53.
RainsfordKD. Mechanisms of gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. Scand J Gastroenterol. 1989;24:9-16.
54.
CastellsagueJRiera-GuardiaN, et al.Individual NSAIDs and upper gastrointestinal complications. Drug Saf. 2012;35(12):1127-1146.
55.
MooreNVanganseELeparcJ-M, et al.The PAIN study: Paracetamol, aspirin and ibuprofen new tolerability study. Clin Drug Invest. 1999;18(2):89-98.
