Nichtsteroidale Antirheumatika (NSAR) in der perioperativen Phase in Traumatologie und Orthopädie

Beck, Alexander; Salem, Khaled Hamed; Krischak, Gert; Kinzl, L.; Bischoff, Mark; Schmelz, Andreas

doi:10.1007/s00064-005-1152-0

Cited by 34 publications

(9 citation statements)

References 36 publications

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“…In acute pain after fracture or during the postoperative period after fracture fixation, NSAIDs play an important role due to their pronounced analgesic potency, anti-inflammatory effects, and lesser side effects compared to opioids [7, 45]. However, studies comparing opiates and NSAIDs have shown that NSAIDs are at least as effective as opiates with some studies suggesting that NSAIDs can achieve greater reductions in pain scores [46–52].…”

Section: Introductionmentioning

confidence: 99%

Do Nonsteroidal Anti-Inflammatory Drugs Affect Bone Healing? A Critical Analysis

Pountos

Georgouli

Calori

et al. 2012

The Scientific World Journal

238

161

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Nonsteroidal anti-inflammatory drugs (NSAIDs) play an essential part in our approach to control pain in the posttraumatic setting. Over the last decades, several studies suggested that NSAIDs interfere with bone healing while others contradict these findings. Although their analgesic potency is well proven, clinicians remain puzzled over the potential safety issues. We have systematically reviewed the available literature, analyzing and presenting the available in vitro animal and clinical studies on this field. Our comprehensive review reveals the great diversity of the presented data in all groups of studies. Animal and in vitro studies present so conflicting data that even studies with identical parameters have opposing results. Basic science research defining the exact mechanism with which NSAIDs could interfere with bone cells and also the conduction of well-randomized prospective clinical trials are warranted. In the absence of robust clinical or scientific evidence, clinicians should treat NSAIDs as a risk factor for bone healing impairment, and their administration should be avoided in high-risk patients.

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Section: Introductionmentioning

confidence: 99%

Do Nonsteroidal Anti-Inflammatory Drugs Affect Bone Healing? A Critical Analysis

Pountos

Georgouli

Calori

et al. 2012

The Scientific World Journal

238

161

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“…The literature provides numerous clinical trials which found that an oral HO prophylaxis (indomethacin) can reduce the incidence of large HO formations (Brooker grades 3 and 4) after certain fractures [ 13 ]. It must be taken into account that NSAIDs can lead to delayed fracture healing and non-unions in animals [ 3 , 4 ]. Despite these results, many patients receive NSAIDs for both, postoperative pain and anti-inflammatory (HO prophylactic) treatment after trauma.…”

Section: Discussionmentioning

confidence: 99%

“…Little is known about the significance of HO prophylaxis in blunt extremity trauma and fracture treatment. Nevertheless, some studies have suggested that NSAIDs, which suppress inflammatory prostaglandins during initial tissue inflammation, could cause delayed fracture healing in animals [ 3 , 4 ]. Large and symptomatic HO formations can only be treated surgically [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Current therapeutic strategies of heterotopic ossification – a survey amongst orthopaedic and trauma departments in Germany

Winkler¹,

Wagner²,

Weber³

et al. 2015

BMC Musculoskelet Disord

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BackgroundHeterotopic ossification (HO) is a complication after tissue trauma, fracture and surgery (i.e. total hip arthroplasty). Prophylaxis is the most effective therapy. If HO formations become symptomatic and limit patients’ quality of life, revision surgery is indicated and is usually combined with a perioperative oral prophylaxis (NSAIDs) and/or irradiation. However, a long-term use of NSAIDs can induce gastro-intestinal or cardiac side-effects and possible bony non-unions during fracture healing. Subject of this study was to assess the current status of HO prophylaxis after injuries or fractures and to evaluate current indications and strategies for excision of symptomatic HO.MethodsBetween 2013 and 2014, a questionnaire was sent to 119 orthopaedic and trauma surgery departments in Germany. Participation was voluntary and all acquired data was given anonymously.ResultsThe cumulative feedback rate was 71 %. Trauma and orthopaedic surgery departments in Germany recommend oral HO prophylaxis after acetabulum and femoral neck fractures, elbow dislocation, and fracture or dislocation of the radial head. Pain upon movement and an increasing loss of range of motion in the affected joint are considered to be clear indications for HO surgery. A partial removal of ROM-limiting HO formations was also considered important. The vast majority of all departments include perioperative oral HO prophylaxis and/or irradiation if surgical HO removal is planned. The choice and duration of NSAIDs is highly variable.ConclusionHO is of clinical significance in current traumatology and orthopaedics. Certain fractures and injuries are prone to HO, and prophylactic measures should be taken. The respondents in this survey assessed current therapeutic strategies for HO formations similarly. These concepts are in line with the literature. However, the duration of perioperative oral HO prophylaxis varied greatly among the specialist centres. This is significant as a long-term use of NSAIDs fosters a potential risk for the patients’ safety and could influence the clinical outcome. National and international guidelines need to be developed to further reduce HO rates and improve patients’ safety in trauma and orthopaedic surgery.

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“…Today, the most commonly used drugs for pain relief in these patients are nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac. Diclofenac is an analgesic, anti-inflammatory drug and one of the most efficient inhibitors of prostaglandins which is used in treatment of rheumatic diseases ( 7 , 8 ). Diclofenac could lead to headache, dizziness, rash, edema, and kidney and liver damage.…”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of B and E Vitamins with Diclofenac in Reducing Pain Due to Osteoarthritis of the Knee

Dehghan

2015

Med Arh

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Background:Knee osteoarthritis is one of the most prevalent chronic disorders. Several pharmacological and non pharmacological approaches are used to treat this disease. Today, the effect of B and E vitamins on rheumatology diseases is being discussed. In this study, the efficacy of B and E vitamins accompanied with diclofenac on pain relief in patients with knee osteoarthritis was investigated and compared.Methods:In this double-blinded clinical trial, 120 patients with knee osteoarthritis referring training Rheumatology and Orthopedics Clinic of Shahrekord University of Medical sciences were investigated. Of these patients, 12 were excluded throughout the study. The patients underwent treatment in three groups (oral diclofenac + oral B vitamin, oral diclofenac + oral vitamin E, and oral diclofenac + placebo). Pain relief was assessed by visual analogue scale (VAS) questionnaire and morning stiffness and physical function were assessed by WOMAC standard questionnaire at three times; the first examination, two weeks, and three weeks after referring.Results:The mean score of WOMAC questionnaire at VASs of knee pain, total pain severity, knee joint stiffness, and function of the last 48 hours decreased significantly in all three groups (diclofenac, E and B vitamins) from the first to third examination (P<0.001). Decrease in VAS of knee pain and function of the last 48 hours was higher in B vitamin group than the diclofenac and E vitamin group (P=0.008) and decrease in total pain severity was reported higher in B vitamin group than E vitamin and diclofenac group (P=0.019). Decrease in knee joint stiffness underwent a similar trend in the three groups.Conclusion:In view similar analgesic and anti-inflammatory properties, as well as very few, non prevalent complications of B and E vitamins, use of two or more drugs with a different mechanism of effect seems necessary to enhance their effect on osteoarthritis treatment.

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Nichtsteroidale Antirheumatika (NSAR) in der perioperativen Phase in Traumatologie und Orthopädie

Cited by 34 publications

References 36 publications

Do Nonsteroidal Anti-Inflammatory Drugs Affect Bone Healing? A Critical Analysis

Do Nonsteroidal Anti-Inflammatory Drugs Affect Bone Healing? A Critical Analysis

Current therapeutic strategies of heterotopic ossification – a survey amongst orthopaedic and trauma departments in Germany

Comparative Effectiveness of B and E Vitamins with Diclofenac in Reducing Pain Due to Osteoarthritis of the Knee

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