It is increasingly recognized that non-opioid analgesia important analgesia in the perioperative period. Specifically, NSAIDs (nonsteroidal anti-inflammatory drugs) have been touted as an adjunct or even replacement for opioids. However, uptake of NSAIDs has been slow due to concern for side effects, including bleeding. We sought to understand the risk of bleeding caused by NSAIDs in the perioperative period.
A physician-librarian team performed a search of electronic databases (MEDLINE, EMBASE), using search terms covering the targeted intervention (use of NSAIDs) and outcomes of interest (surgical complications, bleeding), limited to English language articles of any date. We performed a systematic review and meta-analysis of the data.
A total of 2,521 articles were screened and 229 were selected on the basis of title and abstract for detailed assessment. Including reference searching, 74 manuscripts met inclusion criteria spanning years 1987-2019. These studies included 151,031 patients. Studies included 12 types of NSAIDs, the most common being ketorolac, diclofenac and ibuprofen over a wide-range of procedures from ENT, breast, abdomen, plastics, and more. Over half were randomized control trials. The meta-analyses for hematoma, return to the operating room for bleeding and blood transfusions showed no difference in risk in any of three categories studied between the NSAID versus non-NSAID groups (p=0.49, p=0.79 and p=0.49, respectively). Quality scoring found a wide range of quality with scores ranging from lowest quality of 12 to highest quality of 25 out of a total of 27 (average=16).
NSAIDs are unlikely to be the cause of post-operative bleeding complications. This literature covers a large number of patients and remains consistent across types of NSAIDs and operations.