Perioperative Use of Nonsteroidal Anti-Inflammatory Drugs

Abstract

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is well established as a part of multimodal perioperative analgesia treatment, especially in day-case surgery where opioid sparing is important. The aim of this study was to assess the current perioperative use of NSAIDs, the specific drugs used, and the route by which they were administered. A pilot study was undertaken, followed by a second, larger study. Numbered questionnaires were sent to all members of the anaesthetic departments of six target National Health Service Hospitals within the south of the UK. The questionnaires asked specific questions relating to the use of NSAIDs in their departments during the preoperative, perioperative and postoperative periods. Responses to the questionnaires were anonymous except for the identity of the hospital concerned. The pilot study indicated that perioperative NSAIDs continue to be used by anaesthetists and this was confirmed by the second audit. In total, 371 questionnaires were sent out, with 51% of recipients (189/371) responding. All of the respondents reported using NSAIDs (diclofenac, ibuprofen, ketorolac, ketoprofen and parecoxib), with many of the respondents using more than one NSAID. Diclofenac was the most commonly used NSAID overall. However, some of the NSAIDs - notably ketorolac (41% of respondents), diclofenac (61% of respondents) and ketoprofen (7% of respondents) were not used according to the manufacturer's recommendations. These data reveal that NSAIDs were still widely used as analgesics for many surgical procedures at the time of the audit. Intravenous (IV) NSAID administration is the preferred route because of its reliability and speed of onset. The results of this audit indicated significant use of IV NSAIDs (ketorolac, diclofenac and ketoprofen) not in accordance with manufacturers' recommendations, with some NSAIDs even being used in the absence of a product licence for use by the IV route. This may be due to a lack of a satisfactory licensed product. A new formulation of IV diclofenac may fulfil this currently unmet need.