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Adverse effects of perioperative paracetamol, NSAID s, glucocorticoids, gabapentinoids and their combinations: a topical review
Author(s) -
MATHIESEN O.,
WETTERSLEV J.,
KONTINEN V. K.,
POMMERGAARD H.C.,
NIKOLAJSEN L.,
ROSENBERG J.,
HANSEN M. S.,
HAMUNEN K.,
KJER J. J.,
DAHL J. B.
Publication year - 2014
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12380
Subject(s) - medicine , perioperative , adverse effect , pregabalin , acetaminophen , opioid , sedation , anesthesia , number needed to harm , intensive care medicine , analgesic , incidence (geometry) , clinical trial , number needed to treat , confidence interval , relative risk , physics , receptor , optics
Post‐operative pain affects millions of patients worldwide and the post‐operative period has high rates of morbidity and mortality. Some of this morbidity may be related to analgesics. The aim of this review was to provide an update of current knowledge of adverse events ( AE ) associated with the most common perioperative non‐opioid analgesics: paracetamol, non‐steroidal anti‐inflammatory drugs ( NSAID s), glucocorticoids ( GCCs ), gabapentinoids and their combinations. The review is based on data from systematic reviews with meta‐analyses of analgesic efficacy and/or adverse effects of perioperative non‐opioid analgesics, and randomised trials and cohort/retrospective studies. Generally, data on AE are sparse and related to the immediate post‐operative period. For paracetamol, the incidence of AE s appears trivial. Data are inconclusive regarding an association of NSAID s with mortality, cardiovascular events, surgical bleeding and renal impairment. Anastomotic leakage may be associated with NSAID usage. No firm evidence exists for an association of NSAID s with impaired bone healing. Single‐dose GCC s were not significantly related to increased infection rates or delayed wound healing. Gabapentinoid treatment was associated with increased sedation, dizziness and visual disturbances, but the clinical relevance needs clarification. Importantly, data on AE s of combinations of the above analgesics are sparse and inconclusive. Despite the potential adverse events associated with the most commonly applied non‐opioid analgesics, including their combinations, reporting of such events is sparse and confined to the immediate perioperative period. Knowledge of benefit and harm related to multimodal pain treatment is deficient and needs clarification in large trials with prolonged observation.