Controversies in the Perioperative Use of Nonsteroidal Anti inflammatory Drugs

Souter, Andrew J.; Fredman, Brian; White, Paul F.

doi:10.1097/00132586-199506000-00041

Cited by 22 publications

(49 citation statements)

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“…(Table IV) This is not absolute proof of safety of these drugs in respect to kidney function (such a study would required 5000 patients per group to be studied) but it is reassuring that two doses of NSAIDs in a selected group of patients does not induce severe renal dysfunction postoperatively. 10,11 However, because of the remote possibility of side effects inherent in the action of NSAIDs we limited the category of patients in whom we would administer NSAIDs after cardiac surgery as per our study requirements. (Maximum two doses of NSAIDs, excluding patients >75 yr, diabetics, patients with elevated creatinine concentration or with a history of peptic ulcer.…”

Section: Resultsmentioning

confidence: 99%

“…This prospective, randomized, double-blind and placebo-controlled study was designed to evaluate the efficacy and safety (postoperative bleeding, renal function and nausea) of three nonsteroidal anti-inflammatory agents; diclofenac, ketoprofen and indomethacin for pain control in CABG patients. The choice of these particular drugs was dictated by our clinical experience with indomethacin used by us for pain control after cardiac surgery, 10 safer profile of diclofenac and widely advertised analgesic property of ketoprofen.…”

Section: Discussionmentioning

confidence: 99%

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Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery

Hynninen

Cheng

Hossain

et al. 2000

Can J Anesth/J Can Anesth

100

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Purpose: Non-steroidal anti-inflammatory drugs (NSAIDs) are used as analgesic in postoperative pain to reduce opioid side effects, such as drowsiness and nausea. However, NSAIDs have not been used extensively in cardiac surgical patients due to the fear of untoward effects on gastric, renal, and coagulation parameters. This study will evaluate the efficacy and safety of three NSAIDs for pain control in CABG patients. Methods:One hundred and twenty patients scheduled for elective CABG surgery were enrolled in randomized, double blind, controlled study. Standardized fast track cardiac anesthesia was used. One dose of drug (75 mg diclofenac, 100 mg ketoprofen, 100 mg indomethacin, or placebo) was given pr one hour before tracheal extubation and a second dose 12 hr later. Pain was treated with morphine iv and acetaminophen po. Visual analogue pain scores were recorded at baseline, 3, 6, 12 and 24 hr after the first dose of drug.Results: There were no differences among the groups in pain scores. Only patients who received diclofenac required less morphine than patients in the control group (P < 0.05). When the total amounts of pain medications were computed to morphine equivalents, only patients in the diclofenac group received less pain medications than the placebo group (P < 0.05). Proportion of patients with postoperative increase of creatinine level (20% and over) did not differ between placebo and drug groups.Conclusion: Non-steroidal anti-inflammatory drugs may be used for analgesia management post CABG surgery in selected patients. Diclofenac appears to have the best analgesic effects by reducing the morphine and other analgesic requirement postoperatively.Objectif: Les anti-inflammatoires non stéroïdiens (AINS) servent d'analgésique postopératoire et réduisent les effets secondaires des opioïdes, comme la somnolence et les nausées. Leur emploi en cardiochirurgie est plutôt restreint où on craint des effets gastriques et rénaux indésirables et des modifications de la coagulation. On a voulu évaluer l'efficacité et la sécurité d'emploi analgésique de trois AINS chez des patients qui subissent un pontage aortocoronarien.Méthode : L'étude randomisée, contrôlée et à double insu a porté sur 120 patients qui devaient subir un pontage aortocoronarien. Une anesthésie cardiaque normalisée pour un séjour hospitalier écourté a été utilisée. Une dose de médicament (75 mg de diclofénac, 100 mg de kétoprofène, 100 mg d'indométhacine, ou un placebo) a été administrée pr une heure avant l'extubation endotrachéale et une seconde dose 12 h plus tard. La douleur a été traitée avec de la morphine iv et de l'acétaminophène po. Les scores de douleur ont été enregistrés à l'échelle visuelle analogique au début, puis 3, 6, 12 et 24 h après la première dose de médicament.Résultats : Les scores de douleur n'ont pas présenté de différence intergroupe. Seuls les patients du groupe diclofénac ont demandé moins de morphine que ceux du groupe témoin (P < 0,05). Lorsque les quantités totales d'analgésiques ont été calculées en équivalents de...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery

Hynninen

Cheng

Hossain

et al. 2000

Can J Anesth/J Can Anesth

100

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“…Acredita-se que nos serviços onde se utiliza a insuflação de dióxi-do de carbono intrapleural, o deslocamento mediastinal causado por isto resulte em estiramento da pleura e ativação das vias de dor 19 . Antiinflamatórios não-esteróides, salvo se houver contra-indicações, podem ser utilizados para dor pós-toracoscopia, sendo uma alternativa eficaz e segura aos opióides reduzindo a sua necessidade no pós-operatório 20 . Devido ao início de ação mais lento dos AINE em relação ao curto período de duração da simpatectomia toracoscópica, geralmente há necessidade de suplementação da analgesia com opióides.…”

Section: Cuidados Pós-operatóriosunclassified

“…It is believed that when intrapleural carbon dioxide inflation is used, mediastinum shift results in pleural stretch and pain pathways activation 19 . NSAIDs, except for counterindications, may be used for post thoracoscopy pain, being an effective and safe alternative to opioids and decreasing their postoperative need 20 . Due to slower NSAIDs onset as compared to the short length of thoracoscopic sympathectomy there is in general need to supplement analgesia with opioids.…”

Section: Anesthesia With Single Tracheal Tubementioning

confidence: 99%

Simpatectomia por videotoracoscopia no tratamento da hiperhidrose palmar: implicações anestésicas

Dias¹,

Burlamaque²,

Bagatini³

et al. 2005

Rev. Bras. Anestesiol.

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RESUMODias MDL, Burlamaque AA, Bagatini A, Ribas FA, Gomes CRSimpatectomia por Videotoracoscopia no Tratamento da Hiperhidrose Palmar: Implicações Anestésicas JUSTIFICATIVA E OBJETIVOS: A hiperhidrose primária é uma desordem caracterizada por sudorese excessiva difusa ou l o c a l i za d a . E x i s t e m i n ú me r o s mé t o d o s t e r a p ê u t i c o s não-invasivos em vários hospitais e seu número é crescente. A não s e r q u e o c o r r a m c o n t r a -i n d i c a ç õ e s e s p e c í f i c a s , a simpatectomia é realizada bilateralmente, sob anestesia geral, através de um tubo de duplo lúmen ou tubo simples com ou sem associação de insuflação de dióxido de carbono intrapleural. Os principais cuidados pós-operatórios são o diagnóstico precoce de pneumotórax ou hemotórax residual, prevenção de náuseas e vômitos e controle da dor pós-operatória. CONCLUSÕES: A simpatectomia torácica é método eficaz para o tr a ta me n t o d a h i p e r h i d r o s e pa l ma r e o n ú me r o d e procedimentos é crescente. A introdução da videotoracoscopia U n i t e r m o s : C I R U R G I A , To r á c i c a : s i m p a t e c t o m i a , videotoracoscopia; TRATAMENTO: hiperhidrose palmar SUMMARY

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“…For example, in a placebo-controlled study involving ambulatory surgery patients, ketorolac, 30/60 mg IV, given intra-operatively, produced a dose-dependent decrease in post-operative pain scores and opioid analgesic requirements (Souter et al, 1994). Postoperative pain is one of the most prevalent types of acute pain and is an expected result of surgical procedures experienced by thousands of patients all over the world (Ashburn and Ready, 2001).…”

Section: Introductionmentioning

confidence: 99%