Adverse effects of perioperative paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations: a topical review

Acta Anaesthesiologica Scandinavica - Tập 58 Số 10 - Trang 1182-1198 - 2014
Ole Mathiesen1, Jørn Wetterslev2, Vesa Kontinen3, Hans‐Christian Pommergaard4, Lone Nikolajsen5, Jacob Rosenberg4, Mona Sahlholdt Hansen6, Katri Hamunen7, Jens Jørgen Kjer8, Jørgen B. Dahl6
1Section of Acute Pain Management Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
2Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
3Department of Anaesthesia and Intensive Care, Helsinki University Central Hospital, Helsinki, Finland
4Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
5Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark
6Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
7Pain Clinic, Helsinki University Central Hospital, Helsinki, Finland
8Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

Tóm tắt

Post‐operative pain affects millions of patients worldwide and the post‐operative period has high rates of morbidity and mortality. Some of this morbidity may be related to analgesics. The aim of this review was to provide an update of current knowledge of adverse events (AE) associated with the most common perioperative non‐opioid analgesics: paracetamol, non‐steroidal anti‐inflammatory drugs (NSAIDs), glucocorticoids (GCCs), gabapentinoids and their combinations. The review is based on data from systematic reviews with meta‐analyses of analgesic efficacy and/or adverse effects of perioperative non‐opioid analgesics, and randomised trials and cohort/retrospective studies. Generally, data on AE are sparse and related to the immediate post‐operative period. For paracetamol, the incidence of AEs appears trivial. Data are inconclusive regarding an association of NSAIDs with mortality, cardiovascular events, surgical bleeding and renal impairment. Anastomotic leakage may be associated with NSAID usage. No firm evidence exists for an association of NSAIDs with impaired bone healing. Single‐dose GCCs were not significantly related to increased infection rates or delayed wound healing. Gabapentinoid treatment was associated with increased sedation, dizziness and visual disturbances, but the clinical relevance needs clarification. Importantly, data on AEs of combinations of the above analgesics are sparse and inconclusive. Despite the potential adverse events associated with the most commonly applied non‐opioid analgesics, including their combinations, reporting of such events is sparse and confined to the immediate perioperative period. Knowledge of benefit and harm related to multimodal pain treatment is deficient and needs clarification in large trials with prolonged observation.

Từ khóa


Tài liệu tham khảo

10.1016/S0140-6736(08)60878-8

10.1097/ALN.0b013e3181d5f95c

10.1001/jama.2012.5502

10.1503/cmaj.050011

10.1093/bja/aei132

10.1016/S0140-6736(12)61148-9

10.1016/S0140-6736(03)14966-5

10.1097/SLA.0b013e31817f2c1a

10.1517/14656566.2010.499124

DahlJB NielsenRV WetterslevJ NikolajsenL HamunenK KontinenVK HansenMS KjerJJ MathiesenO;Scandinavian Postoperative Pain Alliance (ScaPAlli).Post‐operative analgesic effects of paracetamol NSAIDs glucocorticoids gabapentinoids and their combinations: a topical review.Acta Anaesthesiol Scand2014. doi:10.1111/aas.12382.

10.1002/14651858.CD004602.pub2

10.1002/14651858.CD007126.pub2

10.1093/bja/aei085

10.1097/00000542-200512000-00025

10.3310/hta14170

10.1016/j.pain.2012.12.025

10.1136/ard.2011.200087

10.1136/ard.2011.154047

10.1002/14651858.CD008659.pub2

Bainbridge D, 2006, NSAID‐analgesia, pain control and morbidity in cardiothoracic surgery, CMAJ, 53, 46

10.1213/ANE.0b013e3182334d68

10.3171/SPI/2008/9/7/022

10.1002/14651858.CD002765.pub3

10.1016/j.pain.2004.07.013

10.1093/bja/88.2.227

10.1097/AAP.0b013e31823354f5

10.1097/DCR.0b013e31825fe927

10.1136/bmj.e6166

10.1002/bjs.8691

10.1097/01.prs.0000438459.60474.b5

10.1007/s10350-006-0860-3

10.1159/000193329

10.1002/bjs.6598

10.2106/JBJS.J.01743

10.1097/ALN.0b013e31822a24c2

10.1093/bja/aes431

10.1001/jama.2012.14144

10.1002/14651858.CD005566.pub3

10.2165/00002018-200023050-00007

10.1213/ANE.0b013e318276cf58

10.1111/aas.12270

10.1002/14651858.CD008183.pub2

Seib RK, 2006, Preoperative gabapentin for postoperative analgesia: a meta‐analysis, CMAJ, 53, 461

10.1097/00115550-200605000-00011

10.1016/j.pain.2006.06.018

10.1155/2007/840572

10.1213/01.ane.0000261517.27532.80

10.1186/1471-2253-7-6

10.1097/BRS.0b013e3182a69b90

Moore RA, 2011, Gabapentin for chronic neuropathic pain and fibromyalgia in adults, Cochrane Database Syst Rev

10.1093/bja/aer027

10.1111/j.1399-6576.2011.02471.x

10.1111/j.1528-1167.2010.02966.x

10.1093/bja/88.2.199

10.1093/bja/88.2.215

10.1213/ANE.0b013e3181cf9281

Derry CJ, 2013, Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain, Cochrane Database Syst Rev, 10.1002/14651858.CD010107.pub2

Vries F, 2010, Concomitant use of ibuprofen and paracetamol and the risk of major clinical safety outcomes, Br J Clin Pharmacol, 70, 429, 10.1111/j.1365-2125.2010.03705.x

10.1007/s10787-013-0172-x

10.1056/NEJMp048288

10.1161/CIRCOUTCOMES.109.861104

10.1038/clpt.2008.204

Ofman JJ, 2002, A metaanalysis of severe upper gastrointestinal complications of nonsteroidal antiinflammatory drugs, J Rheumatol, 29, 804

10.1007/s00268-014-2531-1

10.1056/NEJMoa1401105

10.1111/aas.12139

10.1111/j.1399-6576.2007.01415.x

10.1093/bja/aeq333

10.1097/01.sla.0000094390.82352.cb

10.1097/ALN.0b013e31822a2871

10.1093/bja/aet010

10.1016/S0140-6736(04)17523-5

10.1016/S0140-6736(04)17514-4

Thông tin
Thông tin xuất bản

Acta Anaesthesiologica Scandinavica

Tập 58 Số 10

1182-1198

Thông tin tác giả