The Efficacy and Safety of Nonsteroidal Anti-Inflammatory Drugs in Total Joint Arthroplasty: Systematic Review and Direct Meta-Analysis

Yale A. Fillingham, Charles P. Hannon, Karl C. Roberts, Kyle Mullen, Francisco Casambre, Connor Riley, William G. Hamilton, Craig J. Della Valle

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)2739-2758
Number of pages20
JournalJournal of Arthroplasty
Volume35
Issue number10
DOIs
StatePublished - Oct 2020

Keywords

  • ketorolac
  • nonsteroidal anti-inflammatory drugs
  • pain management
  • total hip arthroplasty
  • total knee arthroplasty

Fingerprint

Dive into the research topics of 'The Efficacy and Safety of Nonsteroidal Anti-Inflammatory Drugs in Total Joint Arthroplasty: Systematic Review and Direct Meta-Analysis'. Together they form a unique fingerprint.

Cite this