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Effect of non-steroidal anti-inflammatory drugs on post-surgical complications against the backdrop of the opioid crisis

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Burns & Trauma 2018年第3期6卷 190-198页

作者： Hannah Zhao-Fleming Audrey Hand Kelly Zhang Robert Polak Armand Northcut daron jacob Sharmila Dissanaike Kendra P.Rumbaugh Department of Surgery Texas Tech University Health Sciences Center3601 4th StreetSTOP 8312LubbockTX 79430USA Burn Center of Excellence Texas Tech University Health Sciences CenterLubbockTXUSA School of Medicine Texas Tech University Health Sciences CenterLubbockTXUSA

The USA is currently going through an opioid crisis, associated with tremendous economic and societal impacts. In response to this crisis, healthcare professionals are looking for alternative pain management methods, and non-steroidal anti-inflammatory drugs (NSAIDs) are a sensible choice because of their effectiveness after surgical procedures. However, before surgeons start prescribing NSAIDs in place of opioids, it is crucial to first understand their potential post-surgical complications. The goal of this review is to summarize the data obtained through both animal and human studies, which suggest how a dramatic increase in NSAID use may affect these post-surgical complications. We first provide a short review outlining the mechanisms of action of NSAIDs, followed by a summary of animal studies, which show a trend towards the negative effects of NSAIDs on wound healing and an association between NSAID use and wound infections. Lastly, we present evidence from human studies on the association of NSAIDs with the following complications:anastomotic leaks, necrotizing soft tissue infections, bleeding complications, orthopedic injuries, wound healing, and cancer care. The human studies are much more variable in their conclusions as to whether NSAIDs are beneficial or not, with the only strong evidence showing that NSAIDs inhibit bone healing. This may partially be explained by male and female differences in response to NSAIDs as many animal studies showing the inhibitory effects of NSAIDs were performed on females, while al the human studies were performed with both sexes. We conclude that strong caution should be used in the prescription of NSAIDs, especially in female patients, but larger scale studies are warranted before solid recommendations can be made.

关键词： NSAIDs Opioids Anastomotic leaks Necrotizing soft tissue infections Bleeding Orthopedic injuries Wound healing Cancer care non-steroidal anti-inflammatory

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