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• W2790338411 abstract "Background Postoperative pain is a common consequence of surgery and can have many negative perioperative effects. It has been suggested that the administration of analgesia before a painful stimulus may improve pain control. We defined pre‐emptive nonsteroidal anti‐inflammatories (NSAIDs) as those given before surgery but not continued afterwards and preventive NSAIDs as those given before surgery and continued afterwards. These were compared to a control group given the NSAIDs after surgery instead of before surgery. Objectives To assess the efficacy of preventive and pre‐emptive NSAIDs for reducing postoperative pain in adults undergoing all types of surgery. Search methods We searched the following electronic databases: CENTRAL, MEDLINE, Embase, AMED and CINAHL (up to June 2020). In addition, we searched for unpublished studies in three clinical trial databases, conference proceedings, grey literature databases, and reference lists of retrieved articles. We did not apply any restrictions on language or date of publication. Selection criteria We included parallel‐group randomized controlled trials (RCTs) only. We included adult participants undergoing any type of surgery. We defined pre‐emptive NSAIDs as those given before surgery but not continued afterwards and preventive NSAIDs as those given before surgery and continued afterwards. These were compared to a control group given the NSAIDs after surgery instead of before surgery. We included studies that gave the medication by any route but not given on the skin. Data collection and analysis We used the standard methods expected by Cochrane, as well as a novel publication bias test developed by our research group. We used GRADE to assess the certainty of the evidence for each outcome. Outcomes included acute postoperative pain (minimal clinically important difference (MCID): 1.5 on a 0‐10 scale), adverse events of NSAIDs, nausea and vomiting, 24‐hour morphine consumption (MCID: 10 mg reduction), time to analgesic request (MCID: one hour), pruritus, sedation, patient satisfaction, chronic pain and time to first bowel movement (MCID: 12 hours). Main results We included 71 RCTs. Seven studies are awaiting classification. We included 45 studies that evaluated pre‐emptive NSAIDs and 26 studies that evaluated preventive NSAIDs. We considered only four studies to be at low risk of bias for most domains. The operations and NSAIDs used varied, although most studies were conducted in abdominal, orthopaedic and dental surgery. Most studies were conducted in secondary care and in low‐risk participants. Common exclusions were participants on analgesic medications prior to surgery and those with chronic pain. Pre‐emptive NSAIDs compared to post‐incision NSAIDs For pre‐emptive NSAIDs, there is probably a decrease in early acute postoperative pain (MD ‐0.69, 95% CI ‐0.97 to ‐0.41; studies = 36; participants = 2032; I2 = 96%; moderate‐certainty evidence). None of the included studies that reported on acute postoperative pain reported adverse events as an outcome. There may be little or no difference between the groups in short‐term (RR 1.00, 95% CI 0.34 to 2.94; studies = 2; participants = 100; I2 = 0%; low‐certainty evidence) or long‐term nausea and vomiting (RR 0.85, 95% CI 0.52 to 1.38; studies = 5; participants = 228; I2 = 29%; low‐certainty evidence). There may be a reduction in late acute postoperative pain (MD ‐0.22, 95% CI ‐0.44 to 0.00; studies = 28; participants = 1645; I2 = 97%; low‐certainty evidence). There may be a reduction in 24‐hour morphine consumption with pre‐emptive NSAIDs (MD ‐5.62 mg, 95% CI ‐9.00 mg to ‐2.24 mg; studies = 16; participants = 854; I2 = 99%; low‐certainty evidence) and an increase in the time to analgesic request (MD 17.04 minutes, 95% CI 3.77 minutes to 30.31 minutes; studies = 18; participants = 975; I2 = 95%; low‐certainty evidence). There may be little or no difference in opioid adverse events such as pruritus (RR 0.40, 95% CI 0.09 to 1.76; studies = 4; participants = 254; I2 = 0%; low‐certainty evidence) or sedation (RR 0.51, 95% CI 0.16 to 1.68; studies = 4; participants = 281; I2 = 0%; low‐certainty evidence), although the number of included studies for these outcomes was small. No study reported patient satisfaction, chronic pain or time to first bowel movement for pre‐emptive NSAIDs. Preventive NSAIDs compared to post‐incision NSAIDs For preventive NSAIDs, there may be little or no difference in early acute postoperative pain (MD ‐0.14, 95% CI ‐0.39 to 0.12; studies = 18; participants = 1140; I2 = 75%; low‐certainty evidence). One study reported adverse events from NSAIDs (reoperation for bleeding) although the events were low which did not allow any meaningful conclusions to be drawn (RR 1.95; 95% CI 0.18 to 20.68). There may be little or no difference in rates of short‐term (RR 1.26, 95% CI 0.49 to 3.30; studies = 1; participants = 76; low‐certainty evidence) or long‐term (RR 0.85, 95% CI 0.52 to 1.38; studies = 5; participants = 456; I2 = 29%; low‐certainty evidence) nausea and vomiting. There may be a reduction in late acute postoperative pain (MD ‐0.33, 95% CI ‐0.59 to ‐0.07; studies = 21; participants = 1441; I2 = 81%; low‐certainty evidence). There is probably a reduction in 24‐hour morphine consumption (MD ‐1.93 mg, 95% CI ‐3.55 mg to ‐0.32 mg; studies = 16; participants = 1323; I2 = 49%; moderate‐certainty evidence). It is uncertain if there is any difference in time to analgesic request (MD 8.51 minutes, 95% CI ‐31.24 minutes to 48.27 minutes; studies = 8; participants = 410; I2 = 98%; very low‐certainty evidence). As with pre‐emptive NSAIDs, there may be little or no difference in other opioid adverse events such as pruritus (RR 0.56, 95% CI 0.09 to 3.35; studies = 3; participants = 211; I2 = 0%; low‐certainty evidence) and sedation (RR 0.84, 95% CI 0.44 to 1.63; studies = 5; participants = 497; I2 = 0%; low‐certainty evidence). There is probably little or no difference in patient satisfaction (MD ‐0.42; 95% CI ‐1.09 to 0.25; studies = 1; participants = 72; moderate‐certainty evidence). No study reported on chronic pain. There is probably little or no difference in time to first bowel movement (MD 0.00; 95% CI ‐15.99 to 15.99; studies = 1; participants = 76; moderate‐certainty evidence). Authors' conclusions There was some evidence that pre‐emptive and preventive NSAIDs reduce both pain and morphine consumption, although this was not universal for all pain and morphine consumption outcomes. Any differences found were not clinically significant, although we cannot exclude this in more painful operations. Moreover, without any evidence of reductions in opioid adverse effects, the clinical significance of these results is questionable although few studies reported these outcomes. Only one study reported clinically significant adverse events from NSAIDs administered before surgery and, therefore, we have very few data to assess the safety of either pre‐emptive or preventive NSAIDs. Therefore, future research should aim to adhere to the highest methodology and be adequately powered to assess serious adverse events of NSAIDs and reductions in opioid adverse events." @default.
• W2790338411 created "2018-03-29" @default.
• W2790338411 creator A5010797648 @default.
• W2790338411 creator A5019542232 @default.
• W2790338411 creator A5050794394 @default.
• W2790338411 creator A5066714602 @default.
• W2790338411 creator A5075386403 @default.
• W2790338411 date "2021-06-14" @default.
• W2790338411 modified "2023-10-18" @default.
• W2790338411 title "Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery" @default.
• W2790338411 cites W112096400 @default.
• W2790338411 cites W1235213562 @default.
• W2790338411 cites W13052306 @default.
• W2790338411 cites W136840831 @default.
• W2790338411 cites W1537972189 @default.
• W2790338411 cites W1558572999 @default.
• W2790338411 cites W1825455551 @default.
• W2790338411 cites W185941738 @default.
• W2790338411 cites W1875122213 @default.
• W2790338411 cites W1964300174 @default.
• W2790338411 cites W1967300023 @default.
• W2790338411 cites W1968409311 @default.
• W2790338411 cites W1974055957 @default.
• W2790338411 cites W1975409514 @default.
• W2790338411 cites W1975630991 @default.
• W2790338411 cites W1978519915 @default.
• W2790338411 cites W1982478654 @default.
• W2790338411 cites W1984016877 @default.
• W2790338411 cites W1986214392 @default.
• W2790338411 cites W1987472698 @default.
• W2790338411 cites W1993805691 @default.
• W2790338411 cites W1995021873 @default.
• W2790338411 cites W1995790735 @default.
• W2790338411 cites W1998283767 @default.
• W2790338411 cites W2000557594 @default.
• W2790338411 cites W2001128914 @default.
• W2790338411 cites W2001589248 @default.
• W2790338411 cites W2004373835 @default.
• W2790338411 cites W2018313345 @default.
• W2790338411 cites W2020131209 @default.
• W2790338411 cites W2026321256 @default.
• W2790338411 cites W2030603194 @default.
• W2790338411 cites W2030845766 @default.
• W2790338411 cites W2034670434 @default.
• W2790338411 cites W2036391434 @default.
• W2790338411 cites W2039144110 @default.
• W2790338411 cites W2041928963 @default.
• W2790338411 cites W2044222892 @default.
• W2790338411 cites W2046932471 @default.
• W2790338411 cites W2047954122 @default.
• W2790338411 cites W2048310663 @default.
• W2790338411 cites W2049131783 @default.
• W2790338411 cites W2052038615 @default.
• W2790338411 cites W2053162364 @default.
• W2790338411 cites W2061790396 @default.
• W2790338411 cites W2066496589 @default.
• W2790338411 cites W2068263598 @default.
• W2790338411 cites W2070578916 @default.
• W2790338411 cites W2073925742 @default.
• W2790338411 cites W2074380095 @default.
• W2790338411 cites W2076855643 @default.
• W2790338411 cites W2078659172 @default.
• W2790338411 cites W2080073135 @default.
• W2790338411 cites W2081017730 @default.
• W2790338411 cites W2086187611 @default.
• W2790338411 cites W2087510443 @default.
• W2790338411 cites W2087760665 @default.
• W2790338411 cites W2088095316 @default.
• W2790338411 cites W2102923727 @default.
• W2790338411 cites W2104662830 @default.
• W2790338411 cites W2108143486 @default.
• W2790338411 cites W2109979737 @default.
• W2790338411 cites W2110896744 @default.
• W2790338411 cites W2115712316 @default.
• W2790338411 cites W2123764652 @default.
• W2790338411 cites W2125003309 @default.
• W2790338411 cites W2130141996 @default.
• W2790338411 cites W2133347503 @default.
• W2790338411 cites W2135458294 @default.
• W2790338411 cites W2135473105 @default.
• W2790338411 cites W2137109388 @default.
• W2790338411 cites W2139776244 @default.
• W2790338411 cites W2140108598 @default.
• W2790338411 cites W2140545391 @default.
• W2790338411 cites W2147601261 @default.
• W2790338411 cites W2150998739 @default.
• W2790338411 cites W2153043827 @default.
• W2790338411 cites W2154493320 @default.
• W2790338411 cites W2157823046 @default.
• W2790338411 cites W2157912007 @default.
• W2790338411 cites W2159209109 @default.
• W2790338411 cites W2159733957 @default.
• W2790338411 cites W2161311800 @default.
• W2790338411 cites W2167581782 @default.
• W2790338411 cites W2168429672 @default.
• W2790338411 cites W2185129918 @default.
• W2790338411 cites W2192698759 @default.
• W2790338411 cites W2234100984 @default.
• W2790338411 cites W2315129309 @default.
• W2790338411 cites W2322083285 @default.

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