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CADTH RAPID RESPONSE REPORT: SUMMARY OF ABSTRACTS ... · study17 observed that NSAID use was...
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Service Line: Rapid Response Service
Version: 1.0
Publication Date: April 5, 2018
Report Length: 19 Pages
CADTH RAPID RESPONSE REPORT: SUMMARY OF ABSTRACTS
Perioperative Use of
NSAIDs: Safety and
Guidelines
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 2
Authors: Casey Gray, Charlene Argaez
Cite As: Perioperativ e use of NSAIDs: saf ety and guidelines. Ottawa: CADTH; 2018 Apr. (CADTH rapid response report: summary of abstracts).
Acknowledgments:
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 3
Research Questions
1. What is the clinical evidence regarding the safety and harms of the perioperative use of
nonsteroidal anti-inflammatory drugs (NSAIDs)?
2. What are the evidence-based guidelines regarding the perioperative use of NSAIDs?
Key Findings
Eight systematic reviews (six with meta-analyses), six randomized controlled trials, 21 non-
randomized studies, and three evidence-based guidelines were identified regarding the
perioperative use of NSAIDs.
Methods
A limited literature search was conducted on key resources including PubMed, The
Cochrane Library, University of York Centre for Reviews and Dissemination (CRD)
databases and a focused Internet search. No methodological filters were applied to limit the
retrieval by study type. The search was limited to English language documents published
between January 1, 2013 and March 21, 2018. Internet links were provided, where
available.
Selection Criteria
One reviewer screened citations and selected studies based on the inclusion criteria
presented in Table 1.
Table 1: Selection Criteria
Population Patients (all ages) undergoing surgery
Intervention Nonsteroidal anti-inflammatory drugs (NSAIDs)
Comparator Q1: No treatment with NSAIDs, standard therapy. Q2: No comparator
Outcomes Q1: Safety and harms (e.g., adverse events, anastomotic leak rate, post-operative bleeding) Q2: Evidence-based guidelines
Study Designs Health technology assessments, systematic reviews, meta-analysis, randomized controlled trials, non-
randomized studies, evidence-based guidelines
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 4
Results
Rapid Response reports are organized so that the higher quality evidence is presented first.
Therefore, health technology assessment reports, systematic reviews, and meta-analyses
are presented first. These are followed by randomized controlled trials, non-randomized
studies, and evidence-based guidelines.
Eight systematic reviews (six with meta-analyses), six randomized controlled trials, 21 non-
randomized studies, and three evidence-based guidelines were identified regarding the
perioperative use of NSAIDs. No relevant health technology assessments were identified.
Additional references of potential interest are provided in the appendix.
Overall Summary of Findings
Eight systematic reviews1-8
(six with meta-analyses),2-6,8
six randomized controlled trials ,9-13
and 21 non-randomized studies14-34
were identified regarding the perioperative use of
NSAIDs. Detailed study characteristics are provided in Table 2.
Five studies were identified regarding perioperative NSAID use and anastomotic leaks. One
systematic review showed an increased risk with non-selective NSAIDs and no increased
risk with selective NSAIDs,4 and one systematic review was inconclusive.
1 Three non-
randomized studies reported no difference in anastomotic leaks between NSAID
administration and their comparison groups.14-16
Eight studies with divergent results were identified regarding perioperative NSAID use and
bleeding. Four systematic reviews,2-3,7-8
one randomized controlled trial,13
and three non-
randomized studies18,21-22
showed no relationship between NSAID administration and
postoperative bleeding. The authors of two systematic reviews5-6
and one non-randomized
study17
observed that NSAID use was associated with postoperative bleeding.
One systematic review6 and five randomized controlled trials
9-13 showed that perioperative
NSAID use was not associated with a higher incidence of adverse events compared with
controls. Non-randomized studies reported divergent findings; seven studies20,22-23,25-26,30,32
showed NSAIDs were well tolerated, did not result in adverse events, or resulted in fewer
adverse events when compared to the comparison group, while seven studies21,24,27-29,31,33
showed that NSAIDs were associated with serious or non-serious adverse events.
Three evidence-based guidelines35-37
were identified regarding the perioperative use of
NSAIDs. In the clinical practice guidelines for enhanced recovery after colon and rectal
surgery, the American Society of Colon and Rectal Surgeons and Society of American
Gastrointestinal and Endoscopic Surgeons indicates that there is increased risk of
anastomotic leakage associated with NSAID use after surgery.35
The Institute for Clinical
Systems Improvement (ICSI) included a recommendation to discontinue the use of NSAIDs
preoperatively in their Perioperative protocol and Health care protocol.36
The National
Institute for Health and Care Excellence (NICE) guideline on prevention, detection, and
management of acute kidney injury indicated that there is increased risk of acute kidney
injury in adults with use of NSAIDs after surgery.37
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 5
Table 2: Summary of Included Studies on the Perioperative use of Nonsteroidal Anti-
Inflammatory Drugs (NSAIDs)
First Author,
Year
NSIAD(s) Type of
Surgery
Outcome(s) of
Interest
Results Authors’
Conclusions
Systematic Reviews and Meta-Analyses
Cata, 20171 NR GI cancer Anastomotic
Leaks NR The literature is not
conclusive on whether
the use of NSAIDs is
associated with
anastomotic leaks after
gastrointestinal cancer
surgery
Teerawattananon,
20172
COX-2 inhibitors (celecoxib, parecoxib, or etoricoxib)
NR Postoperative bleeding
Intraoperative blood loss
Postoperative blood loss
No increased risk of
postoperative
bleeding events,
intraoperative blood
loss, or
postoperative blood
loss
Perioperative, single
dose, or short course of
COX-2 inhibitors can be
safely used in
individuals who are
undergoing surgery
Kelley, 20163 Ibuprofen Soft tissue
plastics Postoperative
bleeding
No differences in
bleeding events
between ibuprofen
and comparator
Ibuprofen is a safe
postoperative analgesic
in patients undergoing
common plastic surgery
soft-tissue procedures
Peng, 20164 Selective and
non-selective NSAIDs
GI Anastomotic leak
Overall, NSAIDs
increased
incidence of
anastomotic leak
Non-selective
NSAIDs (but not
selective NSAIDs)
increased the
incidence of
anastomotic leak
compared with
other analgesic
control
The meta-analysis
suggested that
postoperative NSAIDs,
especially nonselective
NSAIDs, could increase
the incidence of
anastomotic leaks
Chan, 20145 Ketorolac Tonsillectomy Hemorrhage Adults, but not
children, have an
increased risk of
post-surgical
hemorrhage with
perioperative
ketorolac use
Ketorolac can be used
safely in children, but is
associated with a five-
fold increased risk of
bleeding in adults
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 6
First Author,
Year
NSIAD(s) Type of
Surgery
Outcome(s) of
Interest
Results Authors’
Conclusions
Gobble, 20146 Ketorolac NR Postoperative
bleeding
AEs
The odds of
postoperative
bleeding were
higher in the
ketorolac group
compared with the
control group
AEs did not differ
between groups
There was a lower
incidence of AEs
with low-dose
ketorolac
Postoperative bleeding
was not significantly
increased with ketorolac
when compared with
controls, and AEs were
not statistically different
between the groups
Lewis, 20137 NR Tonsillectomy
Adenotonsillec-tomy
Bleeding The use of NSAIDs
in children was not
associated with
bleeding requiring
surgical intervention
or bleeding not
requiring surgical
intervention when
compared with other
analgesics or
placebo
There is insufficient
evidence to exclude an
increased risk of
bleeding when NSAIDs
are used in pediatric
tonsillectomy
Riggin, 20138 NR Tonsillectomy Bleeding rates
Bleeding severity
The use of
NSAIDs after
tonsillectomy was
not associated
with bleeding
Use of NSAIDs in
general or in
children was not
associated with
bleeding in
general, most
severe bleeding,
secondary
hemorrhage,
readmission, or
need of
reoperation due to
bleeding
There was no
increased odds of
bleeding for
These results suggest
that NSAIDs can be
considered as a safe
method of analgesia
among children
undergoing
tonsillectomy
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 7
First Author,
Year
NSIAD(s) Type of
Surgery
Outcome(s) of
Interest
Results Authors’
Conclusions
specific NSAIDs in
adults or children
Randomized Controlled Trials
Gago, 20169 IV ibuprofen Abdominal
surgery
Orthopedic
surgery
AEs There was no
difference in AEs
between ibuprofen
and placebo groups
IV-Ibuprofen was safe
and well tolerated
The authors
concluded that 800
mg of IV-Ibuprofen
administered every 6
hours can help
manage postoperative
pain while reducing
the potential risks
associated with
morphine
consumption
Beckmann, 201510
Naproxen Arthroscopic
surgery for
femoroaceta-
bular
impingement
AEs Minor adverse
reactions did not
differ between
naproxen and
placebo
Not relevant
Hovanesian,
201511
Ketorolac Cataract
surgery
AEs Clinically significant
AEs did not differ
between ketorolac
and placebo
The authors determined
that phenylephrine
1.0%-ketorolac 0.3%
administered
intracamerally with
irrigation solution during
cataract surgery was
safe and effective for
maintaining mydriasis
during the procedure
and reducing
postoperative ocular
pain
Shi, 201512
Etoricoxib Lumbar fusion
surgery
AEs No serious AEs Suggest that etoricoxib
was effective in safely
managing the pain
during the lumbar fusion
surgery and recovery
Moss, 201413
IV-Ibuprofen Tonsillectomy AEs
Surgical blood
loss
Postoperative
No significant
differences in the
incidence of SAEs,
surgical blood loss,
Not relevant
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 8
First Author,
Year
NSIAD(s) Type of
Surgery
Outcome(s) of
Interest
Results Authors’
Conclusions
bleeding
Need for
surgical re-
exploration
incidence of
postoperative
bleeding, or a need
for surgical re-
exploration between
Ibuprofen and
placebo groups
Non-Randomized Studies
Haddad, 201714
NR Emergency
general surgery
GI AF (AF;
dehiscence/
leak, fistula, or
abscess)
GI AF rate did not
differ between
NSAID and no
NSAID
Perioperative NSAID
utilization appears to
be safe in patients
undergoing small-
bowel resection and
anastomosis
NSAID administration
should be used
cautiously in patients
with colon or rectal
anastomoses
Rushfeldt, 201615
Ketorolac
Diclofenac
Surgery
involving an
intestinal
anastomosis
Anastomotic
leak
Compared with no
medication
receivers, adjusted
(age, sex, and
propensity score)
odds of anastomotic
leak did not differ for
ketorolac
Other factors than
perioperative drugs are
crucial for risk of AL
Saleh, 201416
Ketorolac Colorectal
resection with
primary
anastomosis
Anastomotic
leak
There was no
difference between
ketorolac and no
ketorolac after
adjusting for
smoking, steroid
use, and age
There does not appear
to be a significant
association between
perioperative ketorolac
use and anastomotic
leakage after colorectal
surgery
Gao, 201817
Ketorolac Circumcision Postoperative
bleeding
Postoperative
admission
Further
medical
intervention
Patients receiving
ketorolac were
more likely to
return to the
emergency
department or
clinic for bleeding
Patients receiving
ketorolac were
more likely to have
Although a promising
analgesic, ketorolac
requires additional
investigation for safe
usage in circumcisions
due to possible
increased risk of
bleeding
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 9
First Author,
Year
NSIAD(s) Type of
Surgery
Outcome(s) of
Interest
Results Authors’
Conclusions
postoperative
sanguineous
drainage
There was no
significant
difference in the
number of patients
requiring
postoperative
admission or
further medical
intervention
Richardson,
201618
Ketorolac Neuro-surgery Radiographic
hemorrhage
Clinically
significant
bleeding
events
There was no
association
between clinically
significant
bleeding events or
radiographic
hemorrhage and
the perioperative
administration of
ketorolac
Short-term ketorolac
therapy does not appear
to be associated with an
increased risk of
bleeding documented
on postoperative
imaging in pediatric
neurosurgical patients
Abdelmageed,
201519
Ketorolac Tonsillec-tomy
with or without
adenoidec-tomy
Bleeding time
Intraoperative
blood loss
Postoperative
bleeding
incidence and
severity
Estimated
intraoperative
blood loss did not
differ between
ketorolac and
paracetamol
Bleeding time
increased
between
preoperative and
postoperative
assessments in
both groups, with
significant
postoperative
elevation in the
ketorolac group
Overall incidence
of post-
tonsillectomy
bleeding did not
differ between
ketorolac and
Pre-emptive ketorolac
infusion during pediatric
tonsillectomy provides
superior postoperative
analgesia with no effect
on intraoperative or
postoperative clinical
bleeding
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 10
First Author,
Year
NSIAD(s) Type of
Surgery
Outcome(s) of
Interest
Results Authors’
Conclusions
paracetamol
groups
Oliveri, 201420
Ketorolac Cardiac surgery GI bleeding
AEs
Ketorolac did not
differ or had
better
postoperative
outcomes than
comparators,
including: GI
bleeding, renal
failure requiring
dialysis,
perioperative,
stroke or transient
ischemic attack,
and death
Treatment with
ketorolac was not
a predictor for
adverse outcome
in this cohort
Ketorolac appears to be
well-tolerated for use
when administered
selectively after cardiac
surgery
Ying, 201821
NR Orthopedic
surgery
AKI The authors
observed a linear
relationship
frequency of NSAID
administration and
postoperative AKI
risk
The authors concluded
that perioperative
NSAID drugs was
significantly associated
with postoperative AKI
Modjahedi, 201722
Topical Cataract
surgery
Postoperative
macular
edema
NSAID use was
associated with a
lower incidence of
postoperative
macular edema in
patients without
diabetes and
diabetics without
retinopathy
NSAID use was
not associated
with a change in
the incidence of
postoperative
macular edema
among patients
with diabetic
Topical NSAIDs were
associated with a
modest reduction of
postoperative macular
edema incidence in
patients undergoing
cataract surgery;
however, this
relationship was not
seen among those
with diabetic
retinopathy
The risk for
postoperative macular
edema is low and the
number of patients
benefiting from
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 11
First Author,
Year
NSIAD(s) Type of
Surgery
Outcome(s) of
Interest
Results Authors’
Conclusions
retinopathy treatment is small
Naseem, 201723
Ketorolac Pediatric
appendectomy
LOS
Readmission
with diagnosis
of peritoneal
abscess or
other
postoperative
infection
Transabdomin
al drainage
performed
Ketorolac was
associated with a
decrease in same-
visit surgical
complications and
not associated
with readmission,
postoperative
LOS, or
postoperative
infection
Ketorolac was
associated with a
decrease in any
complication and
not associated
with readmission,
postoperative
LOS, or
postoperative
infection
Ketorolac was not associated with an increase in postoperative LOS, postoperative infection, or any-cause 30-day readmission
Ketorolac was independently associated with a lower overall rate of postoperative complications
Takahashi, 201724
Ketorolac Laparoscopic
live-donor
nephrectomy
GFR GFR at 1 year was
significantly lower
in patients who
received ketorolac
than in those who
did not
The differences in
GFR and GFR
percentage
between 2 weeks
and 1 year after
surgery was lower
with ketorolac
Urinary
albumin/creatinine
ratio 1 year after
surgery was
significantly higher
in the ketorolac
group compared to
the non-ketorolac
group
Ketorolac use was
Ketorolac appears to be
a risk factor for renal
dysfunction in the long
term after live-donor
nephrectomy
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 12
First Author,
Year
NSIAD(s) Type of
Surgery
Outcome(s) of
Interest
Results Authors’
Conclusions
an independent
risk factor for low
GFR percentage 1
year after surgery
Donohue, 201625
Ketorolac Femoral and
tibial shaft
repair with
intramedullary
rod fixation
Time to union
Average time to
union of the femur
was 147 days for
those
administered
ketorolac and 159
days for group not
administered
ketorolac
Average time to
union of the tibia
was 175 days for
ketorolac and 175
days for no-
ketorolac group
Ketorolac administered
in the first 24 hours after
fracture repair for acute
pain management does
not seem to have a
negative impact on time
to healing or incidence
of nonunion for femoral
or tibial shaft fractures
Lohisinwat, 201626
COX-2
inhibitors
Colorectal
surgery
Postoperative
complications
Median
postoperative
stay
There was no
difference in
overall
postoperative
complications
between COX-2
administration and
no COX-2
administration
Median
postoperative stay
was 1 day shorter
with COX-2
prescription
Perioperative
administration of oral
selective COX-2
inhibitors significantly
decreased intravenous
opioid consumption,
shortened time to GI
recovery and reduced
hospital stay after open
colorectal surgery
Warth, 201627
Celecoxib
Ketorolac
(when
necessary)
Primary and
revision total hip
arthroplasty and
total knee
arthroplasty
AKI NSAIDs use was
associated with a
4.8% rate of AKI,
which is 2.7 times
higher than the
reported literature
Not relevant
Behman, 201528
COX-2 and
non-selective
inhibitors
Pancreatic
duodenectomy
PF NSAID use was
not associated
with PF, or
difference in major
morbidity or
COX-2 inhibitors are
associated with PF in
the early
postoperative period
While non-selective
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 13
First Author,
Year
NSIAD(s) Type of
Surgery
Outcome(s) of
Interest
Results Authors’
Conclusions
mortality
Use of non-
selective inhibitors
was not
associated with an
increase in PF
COX-2 inhibitors
were associated
with increased PF
but no difference
in major morbidity
or mortality
Use of COX-2
inhibitors was
independently
associated with PF
inhibitors appear safe
in this setting, caution
is warranted with the
use of COX-2
inhibitors
Gan, 201529
IV-ibuprofen Not specified SAEs and non-
SAEs
~22% of patients
reported AEs,
including:
infusion site pain
Nine SAEs were
reported and were
judged unrelated
to ibuprofen
Our study found that IV
ibuprofen infused over 5
to 10 minutes at
induction of anesthesia
is a safe administration
option for surgical
patients
Lizardo, 201530
Ketorolac Video-assisted
thorascopic
surgery with
pleurodesis for
pneumothorax
LOS
Radiographic
pneumothorax
resolution prior
to discharge
Ipsilateral
recurrence
rates
There were no
differences in
average LOS,
incidence of residual
pneumothorax at
discharge, or
ipsilateral recurrence
between ketorolac
use and no ketorolac
use
Despite the intrinsic
anti-inflammatory
properties of ketorolac,
our data suggests that
its use for patients
undergoing pleurodesis
for spontaneous
pneumothorax does not
detrimentally influence
the outcomes of surgery
Jian, 201431
Flurbiprofen,
hypertension,
or HES
Craniotomy Post-
craniotomy
intracranial
hematoma
requiring
surgery
Hematoma requiring
surgery was
associated with
flurbiprofen use
during but not after
the surgery. The
intraoperative
infusion of HES
showed no
difference between
patients who had a
Intraoperative and
postoperative
hypertension and the
use of flurbiprofen
during surgery are risk
factors for post-
craniotomy
intracranial hematoma
requiring surgery
The intraoperative
infusion of HES was
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 14
First Author,
Year
NSIAD(s) Type of
Surgery
Outcome(s) of
Interest
Results Authors’
Conclusions
hematoma and
those who did not
not associated with a
higher incidence of
hematoma
STARSurg
Collaborative,
201432
NR GGI surgery Major
complications
NSAID use was
associated with a
reduction in overall
complications
This effect
predominantly
comprised a
reduction in minor
complications with
high-dose NSAIDs
Early use of NSAIDs is
associated with a
reduction in
postoperative adverse
events following major
GI surgery
Beckmann, 201433
Naproxen Hip arthroscopy AEs Complications of
NSAID use included
acute renal failure,
hematochezia from
acute colitis, and
gastritis
Side effects from the
investigated NSAID
regimen can be serious
and should be weighed
against the potential
benefits in preventing
the formation of
Heterotopic Ossification
AE = adv erse ev ent; AF = anastomotic f ailure; AKI = acute kidney injury ; COX = cy clooxy genase; GFR = glomerular f iltration rate; GI = gastrointestinal; HES =
hy droxy ethyl starch; IV = intrav enous; LOS = length of stay ; NR = not reported; NSAID = non-steroidal anti-inf lammatory ; PF = pancreatic f istula; SAEs = serious adv erse
ev ent.
References Summarized
Health Technology Assessments
No literature identified.
Systematic Reviews and Meta-analyses
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inflammatory drugs in the oncological surgical population: beneficial or harmful? A
systematic review of the literature. Br J Anaesth. 2017 Oct 1;119(4):750-64.
PubMed: PM29121285
2. Teerawattananon C, Tantayakom P, Suwanawiboon B, Katchamart W. Risk of
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PubMed: PM27569276
http://www.ncbi.nlm.nih.gov/pubmed/29121285http://www.ncbi.nlm.nih.gov/pubmed/27569276
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 15
3. Kelley BP, Bennett KG, Chung KC, Kozlow JH. Ibuprofen may not increase bleeding
risk in plastic surgery: a systematic review and meta-analysis. Plast Reconstr Surg.
2016 Apr;137(4):1309-16.
PubMed: PM27018685
4. Peng F, Liu S, Hu Y, Yu M, Chen J, Liu C. Influence of perioperative nonsteroidal anti -
inflammatory drugs on complications after gastrointestinal surgery: a meta-analysis.
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 16
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 17
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 18
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34.National Guideline Clearinghouse. Guideline summary: clinical practice guidelines for
enhanced recovery after colon and rectal surgery from the American Society of Colon
and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic
Surgeons. In : National Guideline Clearinghouse [Internet]. Rockville (MD): Agency for
Healthcare Research and Quality; 2017 Aug [cited 2018 Apr 5]. Available from:
https://www.guideline.gov/summaries/summary/51065/clinical-practice-guidelines-for-
enhanced-recovery-after-colon-and-rectal-surgery-from-the-american-society-of-colon-
and-rectal-surgeons-and-society-of-american-gastrointestinal-and-endoscopic-
surgeons?q=nsaid+AND+Perioperat
See section: Potential Harms
35.National Guideline Clearinghouse. Guideline summary: perioperative protocol: health
care protocol. In: National Guideline Clearinghouse [Internet]. Rockville (MD): Agency
for Healthcare Research and Quality; 2014 Mar [cited 2018 Apr 5]. Available from:
https://www.guideline.gov/summaries/summary/48408/perioperative-protocol-health-
care-protocol?q=nsaid+AND+Perioperat
See section: 2.4.2 Drugs to Stop
36.Acute kidney injury: prevention, detection and management [Internet]. London: National
Institute for Health and Care Excellence; 2013 Aug [cited 2018 Apr 5]. (NICE guideline;
no. 169). Available from: https://www.nice.org.uk/guidance/cg169/resources/acute-
kidney-injury-prevention-detection-and-management-pdf-35109700165573
See: Assessing risk factors in adults having surgery, page 11
http://www.ncbi.nlm.nih.gov/pubmed/26385568http://www.ncbi.nlm.nih.gov/pubmed/24966149http://www.ncbi.nlm.nih.gov/pubmed/25091299http://www.ncbi.nlm.nih.gov/pubmed/24664136https://www.guideline.gov/summaries/summary/51065/clinical-practice-guidelines-for-enhanced-recovery-after-colon-and-rectal-surgery-from-the-american-society-of-colon-and-rectal-surgeons-and-society-of-american-gastrointestinal-and-endoscopic-surgeons?q=nsaid+AND+Perioperathttps://www.guideline.gov/summaries/summary/51065/clinical-practice-guidelines-for-enhanced-recovery-after-colon-and-rectal-surgery-from-the-american-society-of-colon-and-rectal-surgeons-and-society-of-american-gastrointestinal-and-endoscopic-surgeons?q=nsaid+AND+Perioperathttps://www.guideline.gov/summaries/summary/51065/clinical-practice-guidelines-for-enhanced-recovery-after-colon-and-rectal-surgery-from-the-american-society-of-colon-and-rectal-surgeons-and-society-of-american-gastrointestinal-and-endoscopic-surgeons?q=nsaid+AND+Perioperathttps://www.guideline.gov/summaries/summary/51065/clinical-practice-guidelines-for-enhanced-recovery-after-colon-and-rectal-surgery-from-the-american-society-of-colon-and-rectal-surgeons-and-society-of-american-gastrointestinal-and-endoscopic-surgeons?q=nsaid+AND+Perioperathttps://www.guideline.gov/summaries/summary/48408/perioperative-protocol-health-care-protocol?q=nsaid+AND+Perioperathttps://www.guideline.gov/summaries/summary/48408/perioperative-protocol-health-care-protocol?q=nsaid+AND+Perioperathttps://www.nice.org.uk/guidance/cg169/resources/acute-kidney-injury-prevention-detection-and-management-pdf-35109700165573https://www.nice.org.uk/guidance/cg169/resources/acute-kidney-injury-prevention-detection-and-management-pdf-35109700165573
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SUMMARY OF ABSTRACTS Perioperativ e use of NSAIDs 19
Appendix — Further Information
Previous CADTH Reports
37. Ketorolac versus non-steroidal anti-inflammatory drugs for the management of acute
pain: comparative clinical effectiveness [Internet]. Ottawa: CADTH; 2017 Jan [cited
2018 Apr 5]. (CADTH Rapid response report: summary of abstracts). Available from:
https://www.cadth.ca/sites/default/files/pdf/htis/2017/RB1055%20Toradol%20vs%20NS
AIDS%20Final.pdf
38. Non-steroidal anti-inflammatory drugs in patients with hypertension, chronic kidney
disease, or heart failure: benefits, harms, and guidelines [Internet]. Ottawa: CADTH;
2015 Mar [cited 2018 Apr 5]. (CADTH Rapid response report: summary of abstracts).
Available from: https://www.cadth.ca/sites/default/files/pdf/htis/mar-
2015/RB0809%20NSAIDs%20for%20HT%20CKD%20and%20HF%20Final.pdf
39. Ketorolac for pain management: a review of the clinical evidence [Internet]. Ottawa:
CADTH; 2014 Jun [cited 2018 Apr 5]. (CADTH Rapid response report: summary of
abstracts). Available from: https://www.cadth.ca/sites/default/files/pdf/htis/nov-
2014/RC0565%20Toradol%20Final.pdf
40. Non-steroidal anti-inflammatory drugs for pain: a review of safety [Internet]. Ottawa:
CADTH; 2013 Aug [cited 2018 Apr 5]. (CADTH Rapid response report: summary with
critical appraisal). Available from:https://www.cadth.ca/sites/default/files/pdf/htis/aug-
2013/RC0471%20NSAID%20safety%20final.pdf
Review Articles
41. Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management
with nonopioid analgesics and techniques: a review. JAMA Surg. 2017 Jul 1;152(7):691-
7.
PubMed: PM28564673
Additional References
42. Scott WW, Levy M, Rickert KL, Madden CJ, Beshay JE, Sarode R. Assessment of
common nonsteroidal anti-inflammatory medications by whole blood aggregometry: a
clinical evaluation for the perioperative setting. World Neurosurg. 2014 Nov;82(5):e633-
e638.
PubMed: PM24698769
https://www.cadth.ca/sites/default/files/pdf/htis/2017/RB1055%20Toradol%20vs%20NSAIDS%20Final.pdfhttps://www.cadth.ca/sites/default/files/pdf/htis/2017/RB1055%20Toradol%20vs%20NSAIDS%20Final.pdfhttps://www.cadth.ca/sites/default/files/pdf/htis/mar-2015/RB0809%20NSAIDs%20for%20HT%20CKD%20and%20HF%20Final.pdfhttps://www.cadth.ca/sites/default/files/pdf/htis/mar-2015/RB0809%20NSAIDs%20for%20HT%20CKD%20and%20HF%20Final.pdfhttps://www.cadth.ca/sites/default/files/pdf/htis/nov-2014/RC0565%20Toradol%20Final.pdfhttps://www.cadth.ca/sites/default/files/pdf/htis/nov-2014/RC0565%20Toradol%20Final.pdfhttps://www.cadth.ca/sites/default/files/pdf/htis/aug-2013/RC0471%20NSAID%20safety%20final.pdfhttps://www.cadth.ca/sites/default/files/pdf/htis/aug-2013/RC0471%20NSAID%20safety%20final.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/28564673http://www.ncbi.nlm.nih.gov/pubmed/24698769