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Preemptive Non-Steroidal Anti-Inflammatory Drugs for Orthopedic Surgery

14 August 2010


Background: Pain and infection are two of the major unwanted outcomes of surgery that physician have long been trying to control. There has been a great deal of advancement to limit pain caused by surgery, from the anesthesia during surgery to the commonly used opioids after surgery. Preemptive analgesia is defined as an anti-nociceptive treatment that prevents establishment of altered processing of afferent input, which can increase postoperative pain. By reducing the level of prostaglandins in your body, NSAIDs help relieve pain any condition causing inflammation, fever, and also prevent clotting. For these reasons it is felt that the use of NSAIDS preemptively could be helpful in decreasing the sensation of pain before it starts. With the discomfort of surgery kept to a minimum, pain medications could be decreased. With the decrease of analgesic medication also comes the decrease of unwanted side effects the worst of these being, opioid addiction or dependancy. Methods: This systematic review examines original research that looks at the preemptive use of NSAIDS in orthopedic surgery and the effects on postoperative pain. There were many articles excluded for their use of vioxx, some that were older and all those that had Dr. Scott Reuben as an author due to fabricated data. Results: Three studies published in the last ten years comparing the use of NSAIDs to placebo and one observationally blinded study during orthopedic surgery where included. These four studies looked at the preemptive use of NSAIDs in orthopedic surgery and either compared it to placebo or no intervention. The articles found did look at postoperative pain and analgesic usage. Conclusion: Non-Steroidal Anti-Inflammatory Drugs have been shown to have a greater postoperative effect on pain relief when given preemptively to those undergoing orthopedic surgery, than currently used postoperative practices. Opioid sparing is possible with preemptive use of NSAIDs, but were NSAIDs to be used every 12 hours after surgery further opioid sparing could be possible as discussed in the Haung et al study.


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