Systematic Review and Meta–Analysis of the Association Between Non–Steroidal Anti–Inflammatory Drugs and Operative Bleeding in the Perioperative Period
Top Cited Papers
- 27 January 2021
- journal article
- conference paper
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 232 (5), 765-790e1
- https://doi.org/10.1016/j.jamcollsurg.2021.01.005
Abstract
Background It is increasingly recognized that non-opioid analgesia is an important analgesia in the perioperative period. Specifically, NSAIDs (nonsteroidal anti-inflammatory drugs) have been touted as an adjunct, or even replacement, for opioids. However, uptake of NSAIDs has been slow due to concern for side effects, including bleeding. We sought to understand the risk of bleeding caused by NSAIDs in the perioperative period. Study design A physician–librarian team performed a search of electronic databases (MEDLINE, EMBASE), using search terms covering the targeted intervention (use of NSAIDs) and outcomes of interest (surgical complications, bleeding), limited to English language articles of any date. We performed a systematic review and meta-analysis of the data. Results A total of 2,521 articles were screened, and 229 were selected on the basis of title and abstract for detailed assessment. Including reference searching, 74 manuscripts met inclusion criteria spanning years 1987–2019. These studies included 151,031 patients. Studies included 12 types of NSAIDs, the most common being ketorolac, diclofenac, and ibuprofen, over a wide–range of procedures, from otorhinolaryngology (ENT), breast, abdomen, plastics, and more. More than half were randomized control trials. The meta-analyses for hematoma, return to the operating room for bleeding, and blood transfusions showed no difference in risk in any of 3 categories studied between the NSAID vs non-NSAID groups (p = 0.49, p = 0.79, and p = 0.49, respectively). Quality scoring found a wide range of quality, with scores ranging from lowest quality of 12 to highest quality of 25, out of a total of 27 (average = 16). Conclusions NSAIDs are unlikely to be the cause of postoperative bleeding complications. This literature covers a large number of patients and remains consistent across types of NSAIDs and operations.Keywords
Funding Information
- Agency for Healthcare Research and Quality
This publication has 96 references indexed in Scilit:
- Preoperative peritonsillar lornoxicam infiltration is not superior to intravenous lornoxicam for pain relief following tonsillectomy in adultsEuropean Journal of Anaesthesiology, 2010
- Effects of Nonsteroidal Antiinflammatory Drugs on Patient-controlled Analgesia Morphine Side EffectsAnesthesiology, 2005
- A Randomized, Double-Blind Comparison Between Parecoxib Sodium and Propacetamol for Parenteral Postoperative Analgesia After Inguinal Hernia Repair in Adult PatientsAnesthesia & Analgesia, 2005
- Measuring inconsistency in meta-analysesBMJ, 2003
- Intravenous Ketoprofen in Thyroid and Parathyroid SurgeryAnesthesia & Analgesia, 2001
- Incidence of Hematoma Associated with Ketorolac after TRAM Flap Breast ReconstructionPlastic and Reconstructive Surgery, 2001
- Ketorolac Tromethamine and Hemorrhage in Tonsillectomy: A Prospective, Randomized, Double‐Blind StudyThe Laryngoscope, 1997
- Continuous Intravenous Administration of Ketorolac Reduces Pain and Morphine Consumption After Total Hip or Knee ArthroplastyAnesthesia & Analgesia, 1995
- Influence of timing on the analgesic effect of intravenous ketorolac after orthopedic surgeryPain, 1995
- The morphine sparing effects of diclofenac sodium following abdominal surgeryAnaesthesia, 1987