Ibuprofen May Not Increase Bleeding Risk in Plastic Surgery: A Systematic Review and Meta-Analysis

Abstract

Background Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are common medications with multiple useful effects including pain relief and reduction of inflammation. However, surgeons commonly hold all NSAIDs peri-operatively because of bleeding concerns. However, not all NSAIDs irreversibly block platelet function. We hypothesized that the use of ibuprofen would have no effect on postoperative bleeding in plastic surgery patients. Methods A literature review was performed using Medline (PubMed), EMBASE, and the Cochrane Collaboration Library for primary research articles on ibuprofen and bleeding. Inclusion criteria were primary journal articles examining treatment of acute postoperative based on any modality. Data related to pain assessment, postoperative recovery, and complications were extracted. Bias assessment and meta-analysis were performed. Results A total of 881 publications were reviewed. Four primary randomized controlled trials were selected for full analysis. Articles were of high quality by bias assessment. No significant difference was noted regarding bleeding events (p = 0.32) and pain control was noted to be equivalent. Conclusion Ibuprofen is a useful medication in the setting of surgery with multiple beneficial effects. This meta-analysis represents a small set of high quality studies that suggests ibuprofen provides equivalent pain control to narcotics. Importantly, ibuprofen was not associated with an increased risk of bleeding. Further large studies will be necessary to elucidate this issue further, but ibuprofen is a safe postoperative analgesic in patients undergoing common plastic surgery soft tissue procedures.

Prescription patterns and opioid usage in sinonasal surgery

“…11,12 In particular, NSAIDs have not been associated with postoperative bleeding and the evidence supporting NSAID use for postoperative analgesia after ESS has an A grade. 11,17 As otolaryngologists adopt these alternative medications and decrease the amount of routinely prescribed opioids, it is likely that the amount of postoperative narcotics used after sinonasal operations will further decrease from the amount observed in this study.…”

“…When not contraindicated due to patient specifics, scheduled acetaminophen, nonsteroidal anti‐inflammatory drugs (NSAIDs), gabapentin, regional nerve blocks (eg, sphenopalatine ganglion, infraorbital), and intraoperative dexamethasone can be used to reduce opioid requirements . In particular, NSAIDs have not been associated with postoperative bleeding and the evidence supporting NSAID use for postoperative analgesia after ESS has an A grade . As otolaryngologists adopt these alternative medications and decrease the amount of routinely prescribed opioids, it is likely that the amount of postoperative narcotics used after sinonasal operations will further decrease from the amount observed in this study.…”

Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery

“…The evidence supporting NSAID use for postoperative analgesia after ESS has an A grade, pursuant to the Grading of Recommendations Assessment, Development and Evaluation approach, and NSAIDs may reduce postoperative opioid consumption . Although many otolaryngologists, particularly in academic medicine, continue to minimize NSAID use due to the theoretical increased risk of bleeding, large cohort studies have failed to demonstrate significant correlation between NSAID use and postoperative bleeding . For patients with known or suspected contraindications to NSAID use, which include bleeding diatheses, gastrointestinal disease, and allergy, a different strategy will be necessary.…”

“…21 Although many otolaryngologists, particularly in academic medicine, continue to minimize NSAID use due to the theoretical increased risk of bleeding, 12 large cohort studies have failed to demonstrate significant correlation between NSAID use and postoperative bleeding. 22,23 For patients with known or suspected contraindications to NSAID use, which include bleeding diatheses, gastrointestinal disease, and allergy, a different strategy will be necessary. Other opioid-sparing analgesic approaches with supporting evidence include gabapentin, pregabalin, and intraoperative intravenous dexamethasone.…”

Safety of preoperative ibuprofen in pediatric tonsillectomy

“…In an in vitro porcine blood study, ibuprofen inhibited platelet aggregation at recommended doses but did not compromise activated partial thromboplastin time or coagulation profile at concentrations up to eight times the recommended dose . Excellent analgesia and increasing evidence of safety have led to more widespread use of ibuprofen in managing postoperative pain . Based on its record of safety, the most recent clinical practice guideline from the American Academy of Otolaryngology–Head and Neck Surgery Foundation recommends ibuprofen to control posttonsillectomy pain in children …”