Nonsteroidal anti-inflammatory drugs in the perioperative period: current controversies and concerns

Girish P Joshi; Henrik Kehlet; Dileep N Lobo

doi:10.1016/j.bja.2024.10.018

Nonsteroidal anti-inflammatory drugs in the perioperative period: current controversies and concerns

Br J Anaesth. 2024 Nov 28:S0007-0912(24)00652-4. doi: 10.1016/j.bja.2024.10.018. Online ahead of print.

Authors

Girish P Joshi¹, Henrik Kehlet², Dileep N Lobo³

Affiliations

¹ Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: girish.joshi@utsouthwestern.edu.
² Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
³ Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK; Division of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

PMID: 39613528
DOI: 10.1016/j.bja.2024.10.018

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX)-2-specific inhibitors provide significant analgesic and opioid-sparing benefits. However, these analgesics are commonly avoided owing to concerns of potential adverse effects. The evidence for NSAID-related adverse effects is conflicting and of poor quality, and these analgesics are safer than what has been implied. Thus, it is imperative that NSAIDs or COX-2-specific inhibitors are administered routinely unless there are well-founded contraindications.

Keywords: acute kidney injury; analgesics; nonsteroidal anti-inflammatory drugs; perioperative pain; persistent postoperative opioid use.

Publication types

Editorial