Preoperative cessation of non steroidal anti-inflammatory drugs in surgical patients - The need for care

Abstract

During a 12-month period, all patients attending the pre-admission clinic for joint replacement surgery at Royal North Shore Hospital were surveyed to assess if they were taking nonsteroidal anti-inflammatory agents (NSAIDs). Details were gathered about NSAID use, duration and associated adverse effects. It is a routine at this hospital due to surgeons' preference that all NSAIDs be ceased five days prior to surgery. Aim(s): The aim of the study was to assess whether this strategy affected preoperative pain. A total of 98 patients (34 male; 64 female, average age 62 years) were enrolled, but nine were lost to follow-up leaving 89 patients in the sample. All ceased NSAIDs prior to surgery. On follow-up (post-surgical) assessment, 56 patients reported either very severe pain, or moderate increase in pain. Thirty-three patients reported either only a mild increase or no change in pain. Of the patients who suffered pain on NSAID cessation, 35 used paracetamol, 14 took paracetamol/codeine products, nine used oxycodone and three used tramadol, as replacement analgesia. Conclusion(s): 1) routine cessation of NSAIDs prior to surgery can result in significant preoperative pain. Anaesthetists should be aware of this and patients should be instructed that alternative analgesics may be needed. 2) Approximately one-third of all patients found that on ceasing their NSAID prior to surgery there was either no increase in pain, or only a very mild increase, not enough to require supplementary analgesia. This suggests that a large proportion of the population taking long term NSAIDs may be doing so for no therapeutic benefit. A 'drug holiday' from time to time in patients taking NSAIDs would be beneficial in determining whether continued use of the drug is indicated.