Managing postoperative pain in adult outpatients: a systematic review and meta-analysis comparing codeine with NSAIDs

Abstract

Outpatient surgical procedures are now more common than inpatient procedures, given the development of less invasive techniques, the drive for health care effi ciency, and improvements in anesthesia and pain manage ment. [1][2][3][4] Postoperative pain management after outpatient pro cedures often includes lowpotency or lowdose opioids. 5 Codeine use is widespread in this setting and codeine remains the most commonly prescribed opioid in many countries, includ ing Canada. [6][7][8][9] However, its efficacy is variable, its potency is low and its use is associated with risks of severe adverse effects and misuse. 10 Amid the ongoing opioid crisis, management of pain and potential opioid misuse is important across all medical and dental specialties. 11 Nonsteroidal antiinflammatory drugs (NSAIDs) are an alter native to lowpotency opioids. The potency, effects and toxicity of NSAIDs depend on the degree to which they inhibit cyclooxy genase 1 and 2 activity. Their main adverse effects are gastro intestinal bleeding, renal impairment and myocardial infarction with longterm use. [12][13][14][15] Postoperative pain can be effectively managed with NSAIDs, and NSAIDs have been shown to reduce opioid consumption in postoperative patients. 16 Given how commonly these medications are used, and the uncer tainty in their comparative efficacy and safety, we sought to compare pain and safety outcomes for codeinebased medications and NSAIDs among adults who underwent outpatient surgery through a system atic review and metaanalysis of randomized controlled trials (RCTs).

Effect of a Postoperative Multimodal Opioid-Sparing Protocol vs Standard Opioid Prescribing on Postoperative Opioid Consumption After Knee or Shoulder Arthroscopy

“…Patients in the intervention group were prescribed all medications on an as-needed basis based on pain levels but were encouraged to use both naproxen and acetaminophen even when experiencing mild pain in the first week following surgery. After consultation with a perioperative pharmacist as well as a review of the existing literature, 500 mg of naproxen taken twice a day was chosen to provide optimal analgesia in the postoperative setting …”

“…After consultation with a perioperative pharmacist as well as a review of the existing literature, 500 mg of naproxen taken twice a day was chosen to provide optimal analgesia in the postoperative setting. 19 The standard care group received a postoperative opioid prescription that aligned with the treating surgeon's current prescribing habits. To mitigate the risk of bias, each surgeon provided a description of their current prescribing habits for each of the included procedures prior to beginning patient enrollment in the study.…”

Delivery of Multimodal Analgesia to Effectively Treat Acute Pain: A Review From Roma Pain Days

“…In a systematic review of 40 studies (n=5,116), nonsteroidal anti-inflammatory drugs (NSAIDs) were compared to codeine for managing acute postoperative pain. Adult outpatients had improved pain scores, better global assessments, and fewer adverse events with NSAIDs compared to codeine for acute pain management [ 1 ], yet codeine is often chosen for the treatment of acute painful conditions. The clinical assessment of acute pain in patients is not always reliable.…”

“…Despite our growing understanding of pain mechanisms, neuroplasticity, and pharmacology [ 3 ], acute pain is still inadequately managed. The most frequently used drugs for acute pain control remain codeine and paracetamol (acetaminophen), although these are not necessarily the most effective or safest pain relievers [ 1 ]. Despite a wealth of studies of acute and chronic pain, scientific data are not reliably translated into clinical practice.…”

Histological changes induced by Piroxicam on the hepatic and renal tissues of mice with and without administration of Peppermint oil

“…Pain is the novel cause of economic and social burden expressed by about 20% of the entire population. Narcotic analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are optional for managing all types of pain, although NSAIDs are preferred above narcotics due to their good efficacy, fewer adverse effects and low drug abuse potential [1]. Piroxicam is a member of the oxicam family.…”