scholarly journals Are NSAIDs Safe? Assessing the Risk-Benefit Profile of Nonsteroidal Anti-inflammatory Drug Use in Postoperative Pain Management

2020 ◽  
pp. 000313482095283
Author(s):  
Ray W. Chang ◽  
Danielle M. Tompkins ◽  
Stephen M. Cohn
Keyword(s):  
Postoperative Pain ◽  
Cardiac Dysfunction ◽  
Postoperative Pain Management ◽  
Review Of The Literature ◽  
Postoperative Pain Control ◽  
Acute Postoperative Pain ◽  
Short Term ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Short Courses

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.

scholarly journals Pain management after open liver resection: Procedure-Specific Postoperative Pain Management (PROSPECT) recommendations

2021 ◽  
pp. rapm-2020-101933
Author(s):  
Audrey Dieu ◽  
Philippe Huynen ◽  
Patricia Lavand'homme ◽  
Hélène Beloeil ◽  
Stephan M. Freys ◽  
...  
Keyword(s):  
Pain Management ◽  
Liver Resection ◽  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Postoperative Pain Management ◽  
Thoracic Epidural Analgesia ◽  
Open Liver Resection ◽  
Thoracic Epidural ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background and objectivesEffective pain control improves postoperative rehabilitation and enhances recovery. The aim of this review was to evaluate the available evidence and to develop recommendations for optimal pain management after open liver resection using Procedure-Specific Postoperative Pain Management (PROSPECT) methodology.Strategy and selection criteriaRandomized controlled trials (RCTs) published in the English language from January 2010 to October 2019 assessing pain after liver resection using analgesic, anesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane databases.ResultsOf 121 eligible studies identified, 31 RCTs and 3 systematic reviews met the inclusion criteria. Preoperative and intraoperative interventions that improved postoperative pain relief were non-steroidal anti-inflammatory drugs, continuous thoracic epidural analgesia, and subcostal transversus abdominis plane (TAP) blocks. Limited procedure-specific evidence was found for intravenous dexmedetomidine, intravenous magnesium, intrathecal morphine, quadratus lumborum blocks, paravertebral nerve blocks, continuous local anesthetic wound infiltration and postoperative interpleural local anesthesia. No evidence was found for intravenous lidocaine, ketamine, dexamethasone and gabapentinoids.ConclusionsBased on the results of this review, we suggest an analgesic strategy for open liver resection, including acetaminophen and non-steroidal anti-inflammatory drugs, combined with thoracic epidural analgesia or bilateral oblique subcostal TAP blocks. Systemic opioids should be considered as rescue analgesics. Further high-quality RCTs are needed to confirm and clarify the efficacy of the recommended analgesic regimen in the context of an enhanced recovery program.

scholarly journals Intravenous ibuprofen as an adjunct in acute postoperative pain: A review

2015 ◽  
Vol 2 (1) ◽  
pp. 21-24
Author(s):  
Alisha Shrestha ◽  
Dong Huang
Keyword(s):  
Postoperative Pain ◽  
Opioid Analgesics ◽  
Postoperative Pain Management ◽  
Self Report ◽  
Verbal Response ◽  
Multimodal Approach ◽  
Response Scale ◽  
Acute Postoperative Pain ◽  
Anti Inflammatory ◽  
Intravenous Ibuprofen

Background: Postoperative pain can have a significant effect on patient recovery. Studies suggest that 82% patients experience some pain following surgery, of those 47% complaining of moderate pain, 39% experiencing severe to very severe pain. The failure to adequately treat postoperative pain is due to limitations of monotherapy with opioid analgesics. Intravenous ibuprofen is a nonsteroidal antiinflammatory drug with anti-inflammatory, antipyretic, and analgesic properties that may be related to prostaglandin synthetase inhibition and have been shown to reduce opioid requirements with better postoperative pain management. This paper reviews analgesic outcomes of intravenous ibuprofen as an adjunct to opioid for acute postoperative pain in adults.Methods: Relevant studies were searched using cochrane database of systematic reviews, embase and pubmed databases using key words about intravenous ibuprofen and postoperative pain that were appropriate to each database.Results: Tools to assess pain intensity such as visual analog scale, verbal response scale and self-report of pain scores at rest and with movement have been studied. Multimodal approach with preemptive use of nonsteroidal anti-inflammatory drugs for treatment of postoperative pain is considered.Conclusion: Randomized controlled trials and other studies concluded that postoperative pain control protocols can now consider inclusion of intravenous ibuprofen as an adjunct in multimodal approach to offer patients a significant analgesic benefit while reducing the risks associated with opioid administration.Journal of Society of Anesthesiologists of Nepal 2015; 2(1): 21-24

Continuous Lateral Sciatic Blocks for Acute Postoperative Pain Management after Major Ankle and Foot Surgery

2002 ◽  
Vol 23 (8) ◽  
pp. 749-752 ◽  
Author(s):  
Jacques E. Chelly ◽  
Jennifer Greger ◽  
Andrea Casati ◽  
Tameem Al-Samsam ◽  
William McGarvey ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Sciatic Nerve ◽  
Vastus Lateralis ◽  
Biceps Femoris ◽  
Postoperative Pain Management ◽  
Foot Surgery ◽  
Postoperative Pain Control ◽  
Acute Postoperative Pain ◽  
Infusion Technique ◽  
Ankle And Foot

We developed a continuous lateral sciatic nerve infusion technique for postoperative analgesia. Methods: A 10-cm insulated Tuohy needle connected to a nerve stimulator was introduced posteriorly between the biceps femoris and vastus lateralis groove 10 cm cephalad from the tip of the patella. After proper positioning of the insulated needle, a 20-gauge catheter was placed in proximity to the sciatic nerve. Results: Continuous lateral sciatic infusion of 0.2% ropivacaine was associated with a significant reduction of morphine consumption by 29% and 62% during postoperative days one and two, respectively, in patients who underwent open reduction and internal fixation of the ankle. Conclusion: Continuous lateral sciatic infusion of 0.2% ropivacaine represents an alternative for acute postoperative pain control after major ankle and foot surgery.

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