Safety and Efficacy of Postoperative Nonsteroidal Anti-inflammatory Drugs in Sports Medicine

Trasolini, Nicholas A.; Yanke, Adam B.; Verma, Nikhil N.; Cole, Brian J.

doi:10.5435/jaaos-d-21-01228

Cited by 6 publications

(6 citation statements)

References 36 publications

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“…Despite the visualized bony edema in our patient, the process of HO formation had likely been progressing for over 10 years when considering its presence on prior radiographs. Although there is some evidence that nonsteroidal anti-inflammatory drugs can reduce the risk of symptomatic HO formation in the postoperative setting for hip arthroscopies, further research is warranted for their indication and effectiveness in managing chronic HO (11).…”

Section: Discussionmentioning

confidence: 99%

Ischiofemoral Impingement Due to an Undiagnosed Pelvic Avulsion Fracture

Warren,

Ahmed,

Raja

2023

Curr Sports Med Rep

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Ischial tuberosity (IT) avulsion fractures are an uncommon cause of injuries in athletes. In this case, a 26-year-old female suffering from posterior right hip pain for over a decade presented with debility and a decrease in athletic function. Notable history included a hamstring strain while sprinting in elementary school. Clinical examination suggested hamstring tendinopathy and ischiofemoral impingement (IFI). Magnetic resonance imaging (MRI) revealed a chronic, fragmented, IT apophyseal avulsion fracture with ischial bursitis and edema within the fragmented bone, suggesting the development of heterotopic ossification (HO). Diagnostic ultrasound revealed signs of IFI, not evident on MRI. Ultrasound-guided corticosteroid injection in her ischial bursa and ischiofemoral space provided complete relief. The patient was able to resume her activities of daily living and sports-related activities without pain. Although interventional treatments may provide temporary pain relief, a multimodal approach is required for the treatment of HO.

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Section: Discussionmentioning

confidence: 99%

Ischiofemoral Impingement Due to an Undiagnosed Pelvic Avulsion Fracture

Warren,

Ahmed,

Raja

2023

Curr Sports Med Rep

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“…In this population, ossification might decrease overall satisfaction [ 15 , 28 ]. A safe dose of pharmacological prophylaxis with a low-dose selective COX-2 inhibitor is a useful adjunct following surgery [ 19 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Low-dose prophylaxis protocol for heterotopic ossification after hip preservation surgery in a sport participants cohort

Olivero,

Capurro,

Reis-Campos

et al. 2023

SICOT-J

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Background: Heterotopic ossification (HO) is a well-known complication of arthroscopic and open surgical treatment of femoroacetabular impingement (FAI). Incidence of heterotopic ossification has been reported in the literature between 0% and 44% after hip arthroscopy and between 18.2% and 25% after anterior mini-open surgery. Currently, pharmacological prophylaxis with NSAIDs and selective COX-2 inhibitors are commonly used and their effectiveness is well documented in literature. Hypothesis: We hypothesized that the low-dose prophylaxis protocol with selective cox-2 inhibitors decreases the risk of heterotopic ossification in open or arthroscopic hip preservation surgery in athletes. Methods: This study is an analysis of prospectively gathered data on 98 sport participant patients who underwent arthroscopic or anterior mini-open treatment for FAI between April 2008 and April 2018. All the patients received postoperative oral prophylaxis with 60 mg etoricoxib once daily for two weeks. Post-operative X-rays were performed at 1, 3, and 12 months after surgery and reviewed by two orthopedic surgeons blinded to the type and side of surgery. HO were graded according to the Brooker classification. Descriptive statistics was used to analyze demographic data. Bivariate analysis was performed to analyze the association of HO with each of the following variables: type of surgery, physical activity, time of evolution of symptoms, age at surgery, and sex. Finally, a regression model analysis was performed to determine the presence of confounding effects between variables. Results: The study cohort was composed of 54 patients in the arthroscopic treatment group and 44 patients in the anterior mini-open group. HO was identified in 6 (13.6%) patients in the mini-open group. No HO was identified in the arthroscopic group. In the bivariate analysis, “type of surgery” was the only variable that showed a statistically significant association with HO (p = 0.007). Conclusion: Results of this study suggest that anterior mini-open treatment was characterized by a higher risk of HO development compared to hip arthroscopy for femoroacetabular impingement treatment regardless of pharmacological prophylaxis. The treatment regimen of 60 mg etoricoxib daily for two weeks was an effective prophylaxis for HO formation in sport participant patients compared with data available in the literature.

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“…The issue of nonhealing is virtually not relevant for ambulatory practice [27 ▪▪ ,28], not dealing with low rectal anastomosis and fracture of long bones. A specific issue may be the use with tendon sutures in rotator cuff surgery, as there are some data suggesting delayed healing [14,29]. The risk of cardiovascular morbidity will not be an issue before these drugs are used for weeks continuously.…”

Section: The Four Basicsmentioning

confidence: 99%

Pain treatment and prophylaxis on pain

Ræder¹

2022

Current Opinion in Anaesthesiology

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Purpose of reviewAlso in ambulatory surgery, there will usually be a need for analgesic medication to deal with postoperative pain. Even so, a significant proportion of ambulatory surgery patients have unacceptable postoperative pain, and there is a need for better education in how to provide proper prophylaxis and treatment.Recent findingsPostoperative pain should be addressed both pre, intra- and postoperatively. The management should be with a multimodal nonopioid-based procedure specific guideline for the routine cases. In 10–20% of cases, there will be a need to adjust and supplement the basic guideline with extra analgesic measures. This may be because there are contraindications for a drug in the guideline, the procedure is more extensive than usual or the patient has extra risk factors for strong postoperative pain. Opioids should only be used when needed on top of multimodal nonopioid prophylaxis. Opioids should be with nondepot formulations, titrated to effect in the postoperative care unit and eventually continued only when needed for a few days at maximum.SummaryMultimodal analgesia should start pre or per-operatively and include paracetamol, nonsteroidal anti-inflammatory drug (NSAID), dexamethasone (or alternative glucocorticoid) and local anaesthetic wound infiltration, unless contraindicated in the individual case. Paracetamol and NSAID should be continued postoperatively, supplemented with opioid on top as needed. Extra analgesia may be considered when appropriate and needed. First-line options include nerve blocks or interfascial plane blocks and i.v. lidocaine infusion. In addition, gabapentinnoids, dexmedetomidine, ketamine infusion and clonidine may be used, but adverse effects of sedation, dizziness and hypotension must be carefully considered in the ambulatory setting.

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Safety and Efficacy of Postoperative Nonsteroidal Anti-inflammatory Drugs in Sports Medicine

Cited by 6 publications

References 36 publications

Ischiofemoral Impingement Due to an Undiagnosed Pelvic Avulsion Fracture

Ischiofemoral Impingement Due to an Undiagnosed Pelvic Avulsion Fracture

Low-dose prophylaxis protocol for heterotopic ossification after hip preservation surgery in a sport participants cohort

Pain treatment and prophylaxis on pain

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