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The benefits and risks of non‐steroidal anti‐inflammatory drugs for postoperative analgesia in sinonasal surgery: a systematic review and meta‐analysis
Background Non‐steroidal anti‐inflammatory drugs (NSAIDs) have emerged as an alternative to opioids for optimal postoperative pain management. However, the adoption of NSAIDs in sinonasal surgery has been impeded by a theoretical concern for postoperative bleeding. Our objective is to systematically...
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| Published in: | International forum of allergy & rhinology 2023-09, Vol.13 (9), p.1738-1757 |
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| container_end_page | 1757 |
| container_issue | 9 |
| container_start_page | 1738 |
| container_title | International forum of allergy & rhinology |
| container_volume | 13 |
| creator | Lee, Daniel J. Grose, Elysia Brenna, Connor T. A. Philteos, Justine Lightfoot, David Kirubalingam, Keshinisuthan Chan, Yvonne Palmer, James N. Adappa, Nithin D. Lee, John M. |
| description | Background
Non‐steroidal anti‐inflammatory drugs (NSAIDs) have emerged as an alternative to opioids for optimal postoperative pain management. However, the adoption of NSAIDs in sinonasal surgery has been impeded by a theoretical concern for postoperative bleeding. Our objective is to systematically review the efficacy and safety of NSAIDs for patients undergoing sinonasal surgery.
Methods
MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and the WHO International Clinical Trials Registry Platform were searched from inception to January 27, 2022. Randomized controlled trials (RCTs) and comparative observational studies in any language were considered. Screening, data extraction, and risk of bias assessment were performed in duplicate. Our outcomes were postoperative pain scores, requirement for rescue analgesia, and postoperative adverse events (epistaxis, nausea/vomiting).
Results
Out of 4661 records, 15 RCTs (enrolling 1210 patients) and two observational studies were included. Following endoscopic sinus surgery, there was no difference in pain scores between NSAIDs and non‐NSAIDs groups (standardized mean differences [SMD] 0.44 units better, 95% CI –0.18 to 1.05). Following septorhinoplasty, NSAIDs decreased pain scores compared to non‐NSAID regimens (SMD 1.14 units better, 95% CI 0.61 to 1.67 units better). Overall, NSAIDs reduced the need for rescue medication with a relative risk (RR) of 0.45 (95% CI 0.24 to 0.84). In addition, NSAIDs decreased the risk of nausea with an RR of 0.62 (95% CI 0.42 to 0.91) and did not increase the risk of epistaxis (RR 0.72, 95% CI 0.23‐2.22).
Conclusion
Among patients undergoing sinonasal surgery, NSAIDs are beneficial in postoperative pain management and avoidance of postoperative nausea without increasing the risk of postoperative epistaxis. |
| doi_str_mv | 10.1002/alr.23140 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2775618292</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2854855740</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3880-86208fa6ffe5117ca5496efdc43fe98e417fffe23acd7d2099de6c99d198da53</originalsourceid><addsrcrecordid>eNp1kc9u1DAQhy0EolXpgRdAlrjAYVvbif-EW1VRQFoJCe09msbjxSWJF0_SKrc-Ai_Ay_VJcLulByR8sC3PN99Y-jH2WooTKYQ6hT6fqErW4hk7VKJWK9O4-vnT3ZoDdkx0JcrSUmtpX7KDylijrJSH7PfmO_JLHDHEiTiMnudIP4inwMc03t3-oglzih76UpxieYhj6GEYYEp54T7PW-IhZb5LNKUdZpjiNRYW-i1SBB5HTrGogIqC5rzFvHzgwGkp5mKJHc94HfHmYfiAE5QZ9-0LRXrFXgToCY8fzyO2ufi4Of-8Wn_99OX8bL3qKufEyhklXAATAmopbQe6bgwG39VVwMZhLW0oNVVB561Xomk8mq7ssnEedHXE3u21u5x-zkhTO0TqsO9hxDRTq6zVRjrVqIK-_Qe9SnMu3y2U07XT2taiUO_3VJcTUcbQ7nIcIC-tFO19am1JrX1IrbBvHo3z5YD-ifybUQFO98BN7HH5v6k9W3_bK_8AlcOnsw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2854855740</pqid></control><display><type>article</type><title>The benefits and risks of non‐steroidal anti‐inflammatory drugs for postoperative analgesia in sinonasal surgery: a systematic review and meta‐analysis</title><source>Wiley-Blackwell Journals</source><creator>Lee, Daniel J. ; Grose, Elysia ; Brenna, Connor T. A. ; Philteos, Justine ; Lightfoot, David ; Kirubalingam, Keshinisuthan ; Chan, Yvonne ; Palmer, James N. ; Adappa, Nithin D. ; Lee, John M.</creator><creatorcontrib>Lee, Daniel J. ; Grose, Elysia ; Brenna, Connor T. A. ; Philteos, Justine ; Lightfoot, David ; Kirubalingam, Keshinisuthan ; Chan, Yvonne ; Palmer, James N. ; Adappa, Nithin D. ; Lee, John M.</creatorcontrib><description>Background
Non‐steroidal anti‐inflammatory drugs (NSAIDs) have emerged as an alternative to opioids for optimal postoperative pain management. However, the adoption of NSAIDs in sinonasal surgery has been impeded by a theoretical concern for postoperative bleeding. Our objective is to systematically review the efficacy and safety of NSAIDs for patients undergoing sinonasal surgery.
Methods
MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and the WHO International Clinical Trials Registry Platform were searched from inception to January 27, 2022. Randomized controlled trials (RCTs) and comparative observational studies in any language were considered. Screening, data extraction, and risk of bias assessment were performed in duplicate. Our outcomes were postoperative pain scores, requirement for rescue analgesia, and postoperative adverse events (epistaxis, nausea/vomiting).
Results
Out of 4661 records, 15 RCTs (enrolling 1210 patients) and two observational studies were included. Following endoscopic sinus surgery, there was no difference in pain scores between NSAIDs and non‐NSAIDs groups (standardized mean differences [SMD] 0.44 units better, 95% CI –0.18 to 1.05). Following septorhinoplasty, NSAIDs decreased pain scores compared to non‐NSAID regimens (SMD 1.14 units better, 95% CI 0.61 to 1.67 units better). Overall, NSAIDs reduced the need for rescue medication with a relative risk (RR) of 0.45 (95% CI 0.24 to 0.84). In addition, NSAIDs decreased the risk of nausea with an RR of 0.62 (95% CI 0.42 to 0.91) and did not increase the risk of epistaxis (RR 0.72, 95% CI 0.23‐2.22).
Conclusion
Among patients undergoing sinonasal surgery, NSAIDs are beneficial in postoperative pain management and avoidance of postoperative nausea without increasing the risk of postoperative epistaxis.</description><identifier>ISSN: 2042-6976</identifier><identifier>EISSN: 2042-6984</identifier><identifier>DOI: 10.1002/alr.23140</identifier><identifier>PMID: 36762711</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Analgesia ; Clinical trials ; endoscopic sinus surgery ; Epistaxis ; Inflammation ; Meta-analysis ; Nausea ; Nonsteroidal anti-inflammatory drugs ; NSAIDs ; Observational studies ; Pain management ; Pain perception ; Paranasal sinus ; Patients ; rhinoplasty ; Surgery ; Vomiting</subject><ispartof>International forum of allergy & rhinology, 2023-09, Vol.13 (9), p.1738-1757</ispartof><rights>2023 ARS‐AAOA, LLC.</rights><rights>This article is protected by copyright. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3880-86208fa6ffe5117ca5496efdc43fe98e417fffe23acd7d2099de6c99d198da53</citedby><cites>FETCH-LOGICAL-c3880-86208fa6ffe5117ca5496efdc43fe98e417fffe23acd7d2099de6c99d198da53</cites><orcidid>0000-0003-4057-2858 ; 0000-0002-3054-3474 ; 0000-0002-6126-3897</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Falr.23140$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Falr.23140$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36762711$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Daniel J.</creatorcontrib><creatorcontrib>Grose, Elysia</creatorcontrib><creatorcontrib>Brenna, Connor T. A.</creatorcontrib><creatorcontrib>Philteos, Justine</creatorcontrib><creatorcontrib>Lightfoot, David</creatorcontrib><creatorcontrib>Kirubalingam, Keshinisuthan</creatorcontrib><creatorcontrib>Chan, Yvonne</creatorcontrib><creatorcontrib>Palmer, James N.</creatorcontrib><creatorcontrib>Adappa, Nithin D.</creatorcontrib><creatorcontrib>Lee, John M.</creatorcontrib><title>The benefits and risks of non‐steroidal anti‐inflammatory drugs for postoperative analgesia in sinonasal surgery: a systematic review and meta‐analysis</title><title>International forum of allergy & rhinology</title><addtitle>Int Forum Allergy Rhinol</addtitle><description>Background
Non‐steroidal anti‐inflammatory drugs (NSAIDs) have emerged as an alternative to opioids for optimal postoperative pain management. However, the adoption of NSAIDs in sinonasal surgery has been impeded by a theoretical concern for postoperative bleeding. Our objective is to systematically review the efficacy and safety of NSAIDs for patients undergoing sinonasal surgery.
Methods
MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and the WHO International Clinical Trials Registry Platform were searched from inception to January 27, 2022. Randomized controlled trials (RCTs) and comparative observational studies in any language were considered. Screening, data extraction, and risk of bias assessment were performed in duplicate. Our outcomes were postoperative pain scores, requirement for rescue analgesia, and postoperative adverse events (epistaxis, nausea/vomiting).
Results
Out of 4661 records, 15 RCTs (enrolling 1210 patients) and two observational studies were included. Following endoscopic sinus surgery, there was no difference in pain scores between NSAIDs and non‐NSAIDs groups (standardized mean differences [SMD] 0.44 units better, 95% CI –0.18 to 1.05). Following septorhinoplasty, NSAIDs decreased pain scores compared to non‐NSAID regimens (SMD 1.14 units better, 95% CI 0.61 to 1.67 units better). Overall, NSAIDs reduced the need for rescue medication with a relative risk (RR) of 0.45 (95% CI 0.24 to 0.84). In addition, NSAIDs decreased the risk of nausea with an RR of 0.62 (95% CI 0.42 to 0.91) and did not increase the risk of epistaxis (RR 0.72, 95% CI 0.23‐2.22).
Conclusion
Among patients undergoing sinonasal surgery, NSAIDs are beneficial in postoperative pain management and avoidance of postoperative nausea without increasing the risk of postoperative epistaxis.</description><subject>Analgesia</subject><subject>Clinical trials</subject><subject>endoscopic sinus surgery</subject><subject>Epistaxis</subject><subject>Inflammation</subject><subject>Meta-analysis</subject><subject>Nausea</subject><subject>Nonsteroidal anti-inflammatory drugs</subject><subject>NSAIDs</subject><subject>Observational studies</subject><subject>Pain management</subject><subject>Pain perception</subject><subject>Paranasal sinus</subject><subject>Patients</subject><subject>rhinoplasty</subject><subject>Surgery</subject><subject>Vomiting</subject><issn>2042-6976</issn><issn>2042-6984</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><recordid>eNp1kc9u1DAQhy0EolXpgRdAlrjAYVvbif-EW1VRQFoJCe09msbjxSWJF0_SKrc-Ai_Ay_VJcLulByR8sC3PN99Y-jH2WooTKYQ6hT6fqErW4hk7VKJWK9O4-vnT3ZoDdkx0JcrSUmtpX7KDylijrJSH7PfmO_JLHDHEiTiMnudIP4inwMc03t3-oglzih76UpxieYhj6GEYYEp54T7PW-IhZb5LNKUdZpjiNRYW-i1SBB5HTrGogIqC5rzFvHzgwGkp5mKJHc94HfHmYfiAE5QZ9-0LRXrFXgToCY8fzyO2ufi4Of-8Wn_99OX8bL3qKufEyhklXAATAmopbQe6bgwG39VVwMZhLW0oNVVB561Xomk8mq7ssnEedHXE3u21u5x-zkhTO0TqsO9hxDRTq6zVRjrVqIK-_Qe9SnMu3y2U07XT2taiUO_3VJcTUcbQ7nIcIC-tFO19am1JrX1IrbBvHo3z5YD-ifybUQFO98BN7HH5v6k9W3_bK_8AlcOnsw</recordid><startdate>202309</startdate><enddate>202309</enddate><creator>Lee, Daniel J.</creator><creator>Grose, Elysia</creator><creator>Brenna, Connor T. A.</creator><creator>Philteos, Justine</creator><creator>Lightfoot, David</creator><creator>Kirubalingam, Keshinisuthan</creator><creator>Chan, Yvonne</creator><creator>Palmer, James N.</creator><creator>Adappa, Nithin D.</creator><creator>Lee, John M.</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4057-2858</orcidid><orcidid>https://orcid.org/0000-0002-3054-3474</orcidid><orcidid>https://orcid.org/0000-0002-6126-3897</orcidid></search><sort><creationdate>202309</creationdate><title>The benefits and risks of non‐steroidal anti‐inflammatory drugs for postoperative analgesia in sinonasal surgery: a systematic review and meta‐analysis</title><author>Lee, Daniel J. ; Grose, Elysia ; Brenna, Connor T. A. ; Philteos, Justine ; Lightfoot, David ; Kirubalingam, Keshinisuthan ; Chan, Yvonne ; Palmer, James N. ; Adappa, Nithin D. ; Lee, John M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3880-86208fa6ffe5117ca5496efdc43fe98e417fffe23acd7d2099de6c99d198da53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Analgesia</topic><topic>Clinical trials</topic><topic>endoscopic sinus surgery</topic><topic>Epistaxis</topic><topic>Inflammation</topic><topic>Meta-analysis</topic><topic>Nausea</topic><topic>Nonsteroidal anti-inflammatory drugs</topic><topic>NSAIDs</topic><topic>Observational studies</topic><topic>Pain management</topic><topic>Pain perception</topic><topic>Paranasal sinus</topic><topic>Patients</topic><topic>rhinoplasty</topic><topic>Surgery</topic><topic>Vomiting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Daniel J.</creatorcontrib><creatorcontrib>Grose, Elysia</creatorcontrib><creatorcontrib>Brenna, Connor T. A.</creatorcontrib><creatorcontrib>Philteos, Justine</creatorcontrib><creatorcontrib>Lightfoot, David</creatorcontrib><creatorcontrib>Kirubalingam, Keshinisuthan</creatorcontrib><creatorcontrib>Chan, Yvonne</creatorcontrib><creatorcontrib>Palmer, James N.</creatorcontrib><creatorcontrib>Adappa, Nithin D.</creatorcontrib><creatorcontrib>Lee, John M.</creatorcontrib><collection>Open Access: Wiley-Blackwell Open Access Journals</collection><collection>Wiley Online Library</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>International forum of allergy & rhinology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Daniel J.</au><au>Grose, Elysia</au><au>Brenna, Connor T. A.</au><au>Philteos, Justine</au><au>Lightfoot, David</au><au>Kirubalingam, Keshinisuthan</au><au>Chan, Yvonne</au><au>Palmer, James N.</au><au>Adappa, Nithin D.</au><au>Lee, John M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The benefits and risks of non‐steroidal anti‐inflammatory drugs for postoperative analgesia in sinonasal surgery: a systematic review and meta‐analysis</atitle><jtitle>International forum of allergy & rhinology</jtitle><addtitle>Int Forum Allergy Rhinol</addtitle><date>2023-09</date><risdate>2023</risdate><volume>13</volume><issue>9</issue><spage>1738</spage><epage>1757</epage><pages>1738-1757</pages><issn>2042-6976</issn><eissn>2042-6984</eissn><notes>Daniel J. Lee and Elysia Grose shared co‐first authorship.</notes><notes>Daniel J. Lee accepted for Podium Presentation for 2023 American Rhinology Society Meeting at Combined Otolaryngology Spring Meetings.</notes><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-1</notes><notes>content type line 23</notes><notes>ObjectType-Undefined-3</notes><abstract>Background
Non‐steroidal anti‐inflammatory drugs (NSAIDs) have emerged as an alternative to opioids for optimal postoperative pain management. However, the adoption of NSAIDs in sinonasal surgery has been impeded by a theoretical concern for postoperative bleeding. Our objective is to systematically review the efficacy and safety of NSAIDs for patients undergoing sinonasal surgery.
Methods
MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and the WHO International Clinical Trials Registry Platform were searched from inception to January 27, 2022. Randomized controlled trials (RCTs) and comparative observational studies in any language were considered. Screening, data extraction, and risk of bias assessment were performed in duplicate. Our outcomes were postoperative pain scores, requirement for rescue analgesia, and postoperative adverse events (epistaxis, nausea/vomiting).
Results
Out of 4661 records, 15 RCTs (enrolling 1210 patients) and two observational studies were included. Following endoscopic sinus surgery, there was no difference in pain scores between NSAIDs and non‐NSAIDs groups (standardized mean differences [SMD] 0.44 units better, 95% CI –0.18 to 1.05). Following septorhinoplasty, NSAIDs decreased pain scores compared to non‐NSAID regimens (SMD 1.14 units better, 95% CI 0.61 to 1.67 units better). Overall, NSAIDs reduced the need for rescue medication with a relative risk (RR) of 0.45 (95% CI 0.24 to 0.84). In addition, NSAIDs decreased the risk of nausea with an RR of 0.62 (95% CI 0.42 to 0.91) and did not increase the risk of epistaxis (RR 0.72, 95% CI 0.23‐2.22).
Conclusion
Among patients undergoing sinonasal surgery, NSAIDs are beneficial in postoperative pain management and avoidance of postoperative nausea without increasing the risk of postoperative epistaxis.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>36762711</pmid><doi>10.1002/alr.23140</doi><tpages>20</tpages><orcidid>https://orcid.org/0000-0003-4057-2858</orcidid><orcidid>https://orcid.org/0000-0002-3054-3474</orcidid><orcidid>https://orcid.org/0000-0002-6126-3897</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | International forum of allergy & rhinology, 2023-09, Vol.13 (9), p.1738-1757 |
| issn | 2042-6976 2042-6984 |
| language | eng |
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| source | Wiley-Blackwell Journals |
| subjects | Analgesia Clinical trials endoscopic sinus surgery Epistaxis Inflammation Meta-analysis Nausea Nonsteroidal anti-inflammatory drugs NSAIDs Observational studies Pain management Pain perception Paranasal sinus Patients rhinoplasty Surgery Vomiting |
| title | The benefits and risks of non‐steroidal anti‐inflammatory drugs for postoperative analgesia in sinonasal surgery: a systematic review and meta‐analysis |
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