Use of analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) in the emergency room: Therapeutic indications and precautions

Abstract

INTRODUCTION: Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in emergency departments due to their efficacy in relieving pain and reducing inflammation. These medications play a vital role in the management of several acute conditions, including trauma, musculoskeletal pain, and inflammation. However, indiscriminate use without appropriate precautions can result in significant adverse effects, particularly in patients with preexisting comorbidities. Therefore, it is imperative that healthcare professionals understand the specific indications and precautions associated with the use of NSAIDs in emergency settings. OBJECTIVE: This study aims to review and synthesize the recent literature on the indications and precautions for the use of NSAIDs in the emergency department, highlighting the therapeutic benefits and potential risks associated with these medications. METHODOLOGY: An integrative review was conducted using the search terms "NSAIDs", "analgesics", "emergency room" and "precautions" in the SCIELO and PubMed databases, focusing on articles published in the last five years in Brazil. Twenty-five articles were initially identified, of which 12 were selected for detailed analysis based on their relevance and contribution to the topic. RESULTS: The main NSAIDs used in the emergency room include ibuprofen, diclofenac and ketorolac. Ibuprofen is widely used due to its relatively favorable safety profile and efficacy in the management of pain and inflammation. Diclofenac, known for its potent anti-inflammatory action, is indicated in cases of severe pain, but should be used with caution in patients with a history of cardiovascular disease. Ketorolac is frequently used for the management of moderate to severe acute pain, especially after surgical procedures, due to its potent analgesic action. The main precautions for the use of NSAIDs include monitoring of renal and hepatic functions, assessment of gastrointestinal and cardiovascular risks, and consideration of drug interactions. Patients with a history of peptic ulcer, renal insufficiency, or cardiac disease should be carefully evaluated before administering NSAIDs. CONCLUSIONS: The appropriate use of NSAIDs in the emergency department can provide significant relief from pain and inflammation, improving the quality of life of patients. However, it is essential that health care professionals adopt a cautious approach, considering the specific indications and the necessary precautions to minimize the risk of adverse effects. Continuous education and updating on the safety profiles of NSAIDs are essential for safe and effective clinical practice.