NSAIDs in the Treatment of Postoperative Pain

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Gan TJ et al. Cardiovascular safety of hydroxypropyl-beta-cyclodextrin-diclofenac in the management of acute postsurgical pain: a pooled analysis of 2 randomized, double-blind, placebo- and active comparator-controlled phase III clinical trials. J Clin Anesth. 2016;31:249–58. In depth randomized trial that found IV HPβCD-diclofenac to be safe and effective with no increased cardiovascular incidence in postoperative patients.

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Klein M, Andersen LP, Harvald T, Rosenberg J, Gogenur I. Increased risk of anastomotic leakage with diclofenac treatment after laparoscopic colorectal surgery. Dig Surg. 2009;26:27–30.

Klein M, Gogenur I, Rosenberg J. Postoperative use of non-steroidal anti-inflammatory drugs in patients with anastomotic leakage requiring reoperation after colorectal resection: cohort study based on prospective data. BMJ. 2012;345:e6166. This study found that diclofenac treatment resulted in an increased proportion of patients with anastomotic leakage after colorectal surgery and recommend COX-2 to be used with caution.

Kelley B, Bennett K, Chung K, Kozlow J. Ibuprofen may not increase bleeding risk in plastic surgery: a systematic review and meta-analysis. Plast Reconstr Surg. 2016;137(4):1309–16. This article demonstrated that ibuprofen provides equivalent pain control to narcotics in postoperative pain management. There were no increased risks of bleeding.

Gobble RM, Hoang HL, Kachniarz B, Orgill DP. Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials. Plast Reconstr Surg. 2014;133:741–55.

Huang YM, Wang CM, Wang CT, Lin WP, Horng LC, Jiang CC. Perioperative celecoxib administration for pain management after total knee arthroplasty—a randomized, controlled study. BMC Musculoskelet Disord. 2008;9:77.

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Abdul-Hadi O, Parvizi J, Austin MS, Viscusi E, Einhorn T. Nonsteroidal anti- inflammatory drugs in orthopaedics. J Bone Joint Surg Am. 2009;91:2020–7.

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McCormack PL, Scott LJ. Diclofenac sodium injection (Dyloject): in postoperative pain. Drugs. 2008;68(1):123–30.

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