The Efficacy and Safety of Nonsteroidal Anti-Inflammatory Drugs in Total Joint Arthroplasty: Systematic Review and Direct Meta-Analysis
| Autor: | Charles P. Hannon, William G. Hamilton, Connor Riley, Francisco Casambre, Craig J. Della Valle, Karl C. Roberts, Yale A. Fillingham, Kyle Mullen |
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| Rok vydání: | 2020 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty Joint arthroplasty MEDLINE Arthroplasty 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Humans Medicine Orthopedics and Sports Medicine Intensive care medicine Pain Postoperative 030222 orthopedics Nonsteroidal business.industry Anti-Inflammatory Agents Non-Steroidal Perioperative Pain management Ketorolac Critical appraisal Pharmaceutical Preparations chemistry Meta-analysis business medicine.drug |
| Zdroj: | The Journal of Arthroplasty. 35:2739-2758 |
| ISSN: | 0883-5403 |
| Popis: | Background Nonsteroidal anti-inflammatory drugs (NSAIDs) have become widely used to manage perioperative pain following total joint arthroplasty (TJA). The purpose of our study is to evaluate the efficacy and safety of NSAIDs in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management. Methods Databases including MEDLINE, EMBASE, and the Cochrane Central Registry of Controlled Trials were searched for studies published prior to November 2018 on NSAIDs in TJA. Studies included after a systematic review evaluated through direct comparisons and/or meta-analysis, including qualitative and quantitative heterogeneity testing, to evaluate effectiveness and safety of NSAIDs. Results After critical appraisal of 2921 publications, 25 articles represented the best available evidence for inclusion in the analysis. Oral selective cyclooxygenase (COX)-2 and non-selective NSAIDs and intravenous ketorolac safely reduce postoperative pain and opioid consumption during the hospitalization for primary TJA. Administration of an oral selective COX-2 NSAID reduced postoperative opioid consumption after discharge from TKA. Conclusion Strong evidence supports the use of an oral selective COX-2 or non-selective NSAID and intravenous ketorolac as adjunctive medications to manage postoperative pain during the hospitalization for TJA. Although no safety concerns were observed, prescribers need to remain vigilant when prescribing NSAIDs. |
| Databáze: | OpenAIRE |
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