Acute pain management pearls ..Part 3..NSAIDS and paracetamol

Paracetamol is an effective analgesic for acute pain; the incidence of adverse effects comparable to placebo.

Level I Cochrane reviewNon-selective NSAIDs are effective in the treatment of acute postoperative and low back pain, renal colic and primary dysmenorrhoea  (Level I Cochrane review )

With careful patient selection and monitoring, the incidence of nsNSAID-induced perioperative renal impairment is low.(Level I chocrane review)

Non-selective NSAIDs do not increase the risk of reoperation for bleeding after tonsillectomy in paediatric patients.

(Level I Cochrane review)

Coxibs do not appear to produce bronchospasm in individuals known to have aspirinexacerbated respiratory disease.(level I)

Paracetamol given in addition to PCA opioids reduces opioid consumption but does not result in a decrease in opioid-related side effects.( Level I)

Preoperative coxibs reduce postoperative pain and opioid consumption, and increase patient satisfaction.(level I)

Perioperative non-selective NSAIDs increase the risk of severe bleeding after a variety of other operations compared with placebo.(level II)

Coxibs do not impair platelet function; this leads to reduced perioperative blood loss in comparison with non-selective NSAIDs.

The risk of adverse renal effects of non-selective NSAIDs and coxibs is increased in the presence of factors such as pre-existing renal impairment, hypovolaemia, hypotension, use of other nephrotoxic agents and ACE inhibitors