TY - JOUR
T1 - The Efficacy and Safety of Nonsteroidal Anti-Inflammatory Drugs in Total Joint Arthroplasty
T2 - Systematic Review and Direct Meta-Analysis
AU - Fillingham, Yale A.
AU - Hannon, Charles P.
AU - Roberts, Karl C.
AU - Mullen, Kyle
AU - Casambre, Francisco
AU - Riley, Connor
AU - Hamilton, William G.
AU - Della Valle, Craig J.
N1 - Funding Information:
The authors would like to thank the American Association of Hip and Knee Surgeons for providing funding for this study. The authors would like to thank Jayson Murray from the American Academy of Orthopaedic Surgeons Clinical Quality and Value Department for his assistance with oversight of the quality assessment, data extraction, and statistical analysis. Finally, they thank the leadership of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, the American Society of Regional Anesthesia and Pain Medicine, the Hip Society, and the Knee Society for help with organizational support.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/10
Y1 - 2020/10
N2 - Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) have become widely used to manage perioperative pain following total joint arthroplasty (TJA). The purpose of our study is to evaluate the efficacy and safety of NSAIDs in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management. Methods: Databases including MEDLINE, EMBASE, and the Cochrane Central Registry of Controlled Trials were searched for studies published prior to November 2018 on NSAIDs in TJA. Studies included after a systematic review evaluated through direct comparisons and/or meta-analysis, including qualitative and quantitative heterogeneity testing, to evaluate effectiveness and safety of NSAIDs. Results: After critical appraisal of 2921 publications, 25 articles represented the best available evidence for inclusion in the analysis. Oral selective cyclooxygenase (COX)-2 and non-selective NSAIDs and intravenous ketorolac safely reduce postoperative pain and opioid consumption during the hospitalization for primary TJA. Administration of an oral selective COX-2 NSAID reduced postoperative opioid consumption after discharge from TKA. Conclusion: Strong evidence supports the use of an oral selective COX-2 or non-selective NSAID and intravenous ketorolac as adjunctive medications to manage postoperative pain during the hospitalization for TJA. Although no safety concerns were observed, prescribers need to remain vigilant when prescribing NSAIDs.
AB - Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) have become widely used to manage perioperative pain following total joint arthroplasty (TJA). The purpose of our study is to evaluate the efficacy and safety of NSAIDs in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management. Methods: Databases including MEDLINE, EMBASE, and the Cochrane Central Registry of Controlled Trials were searched for studies published prior to November 2018 on NSAIDs in TJA. Studies included after a systematic review evaluated through direct comparisons and/or meta-analysis, including qualitative and quantitative heterogeneity testing, to evaluate effectiveness and safety of NSAIDs. Results: After critical appraisal of 2921 publications, 25 articles represented the best available evidence for inclusion in the analysis. Oral selective cyclooxygenase (COX)-2 and non-selective NSAIDs and intravenous ketorolac safely reduce postoperative pain and opioid consumption during the hospitalization for primary TJA. Administration of an oral selective COX-2 NSAID reduced postoperative opioid consumption after discharge from TKA. Conclusion: Strong evidence supports the use of an oral selective COX-2 or non-selective NSAID and intravenous ketorolac as adjunctive medications to manage postoperative pain during the hospitalization for TJA. Although no safety concerns were observed, prescribers need to remain vigilant when prescribing NSAIDs.
KW - ketorolac
KW - nonsteroidal anti-inflammatory drugs
KW - pain management
KW - total hip arthroplasty
KW - total knee arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=85088099408&partnerID=8YFLogxK
U2 - 10.1016/j.arth.2020.05.035
DO - 10.1016/j.arth.2020.05.035
M3 - Article
C2 - 32690428
AN - SCOPUS:85088099408
SN - 0883-5403
VL - 35
SP - 2739
EP - 2758
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 10
ER -