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Speaker: NSAIDs aid opioid-free pain management, can be used in fusion cases
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LOS ANGELES — NSAIDs used properly in conjunction with spine procedures can be a safe analgesic for spine surgeons to use to manage patients’ postoperative pain without prescribing opioids, a presenter said at the North American Spine Society Annual Meeting, here.
Among the NSAIDs available are non-specific inhibitors like ibuprofen and naproxen, as well as COX-2 inhibitors, Christoph P. Hofstetter, MD, PhD, of the University of Washington in Seattle, said.
“I think NSAIDs are an extremely important part of postoperative pain control,” Hofstetter said.
A recent study, he said, recommended that if NSAIDs are given intraoperatively, these should be given at the end, “right at the skin closure ... That is one take-home message. If you give NSAIDS, you might as well give them at the end of the procedure when you close the skin.”
Hofstetter also said results of a meta-analysis showed NSAID use reduced opioid consumption by 0.72 “and improved the pain scores at both 6 hours, 12 hours and 24 hours. So, that is well established.”
However, he urged surgeons to be aware of and guard against adverse events associated with NSAID use that can cause gastrointestinal issues and other problems, or lead to chronic renal disease.
Hofstetter discussed findings from a 2011 in vitro study by Pountos and colleagues that he said laid the foundation for revisiting the idea that NSAID use inhibits bone formation in patients undergoing spine fusion, particularly with short-term use.
“Maybe NSAIDs do not have such a big effect on bone formation and proliferation of osteocytes,” he said. – by Susan M. Rapp
Reference:
Hofstetter CP. Envisioning a narcotic-free America: Role of spine surgeons. Upside and downfalls of NSAIDs to manage postoperative pain. Presented at: North American Spine Society Annual Meeting; Sept. 26-29, 2018; Los Angeles.
Disclosure: Hofstetter reports he receives consulting fees from Johnson & Johnson paid directly to his institution and has employer and speaking and/or teaching arrangements from Johnson & Johnson paid directly to his institution/employer.