Non-steroidal anti-inflammatory drugs are still used in cardiac surgery [291], despite worsening renal function in some patients. The concomitant administration of other non-steroidal anti-inflammatory drugs can theoretically diminish the antiplatelet effects of low-dose aspirin, increasing the risk for thromboembolic effects (MI and stroke) [292–297]. Nevertheless, RCTs and meta-analyses have shown that the use of low-dose non-steroidal anti-inflammatory drugs in selected patients at low risk of adverse events is effective in reducing pain and opioid consumption and may shorten mechanical ventilation time and stay in the ICU [298–302]. A single propensity-matched study suggested a possible reduction in mortality associated with the use of ketorolac [303]. Therefore, their use as a second-line agent in patients without contraindications may be considered. On the contrary, RCTs showed that selective cyclo-oxygenase-2 inhibitors are associated with an increase in adverse cardiovascular events and should, therefore, not be routinely administered [304, 305]. Analgesic adjuvants can reduce postoperative pain if given preoperatively (gabapentine or pregabalin) or postoperatively (ketamine) [271, 306–308].
Treatment options in managing perioperative pain
 |
 |
|
|
Class of recommendation.
Level of evidence.
References.
For example, allergies, ulcer and liver disease.
AKI: acute kidney injury; CABG: coronary artery bypass grafting; COX: cyclo-oxygenase; ICU: intensive care unit; IV: intravenous; NSAIDs: non-steroidal anti-inflammatory drugs; PAC: patient-controlled analgesia.
Treatment options in managing perioperative pain
|
|
|
|
Class of recommendation.
Level of evidence.
References.
For example, allergies, ulcer and liver disease.
AKI: acute kidney injury; CABG: coronary artery bypass grafting; COX: cyclo-oxygenase; ICU: intensive care unit; IV: intravenous; NSAIDs: non-steroidal anti-inflammatory drugs; PAC: patient-controlled analgesia.
