Using non-steroidal anti-inflammatory drugs (NSAIDs) following pleurodesis

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether non-steroidal anti-inflammatory drugs (NSAIDs) decrease the effect of pleurodesis. Only 17 papers were identified using the search below. Three papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of the papers are tabulated. We conclude that despite a limited number and type of study, there is some histopathological evidence to support the concern that NSAIDs may reduce effectiveness of pleurodesis. Until further clinical studies with appropriate outcome measures are available, NSAIDs following pleurodesis should be used with caution and probably avoided routinely.     

Nonsteroidal anti-inflammatory drugs.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications today. Although their exact mechanism of action is unclear, inhibition of prostaglandin synthesis contributes significantly to their analgesic, anti-inflammatory, antipyretic, and antiplatelet effects. In recent years, additional mechanisms of action have been proposed for NSAIDs, and these may explain the variability commonly noted in patient response and tolerability to individual NSAIDs. NSAID therapy is not without risk, and serious adverse effects involving the gastrointestinal tract, kidneys, blood, and liver have been reported.     

非甾体类抗炎镇痛药与围术期镇痛

近年来,非甾体类抗炎镇痛药(NSAIDs)越来越多地用于围术期镇痛以减少阿片类药的副作用.NSAIDs药物通过抑制环氧化酶而减少前列腺素的合成从而达到镇痛的目的 .此综述将从以下几个方面论述NSAIDs药物用于围术期镇痛:①短小手术后镇痛;②停用PCA以后镇痛;③辅助阿片类药物用于中等和大手术后镇痛;④抗炎效应;⑤超前镇痛.NSAIDs药物主要的副作用是胃肠道反应、出血以及目前关注较多的心血管问题,但短时间用于术后镇痛是很安全的.随着越来越多的选择性或特异性环氧化酶.2抑制剂的研制,NSAIDs药物将为病人带来更安全更有效的围术期多模式镇痛.     

Nonsteroidal anti-inflammatory drugs (NSAIDs), cyxlooxygenase-2 selective inhibitors (coxibs) and gastrointestinal harm: review of clinical trials and clinical practice

Background  

Gastrointestinal harm, known to occur with NSAIDs, is thought to be lower with NSAID and gastroprotective agent, and with inhibitors selective to cyclooxygenase-2 (coxibs) at usual plasma concentrations. We examine competing strategies for available evidence of reduced gastrointestinal bleeding in clinical trials and combine this evidence with evidence from clinical practice on whether the strategies work in the real world, whether guidance on appropriate prescribing is followed, and whether patients adhere to the strategies.     

Nonsteroidal anti-inflammatory drugs and paracetamol in children

The cyclooxygenase enzymes produce large amounts of prostaglandins in presence of tissue injury and inflammation. Prostaglandins exert their influence on nerve membrane excitability both at the peripheral site and at the spinal dorsal horn. Their key role in peripheral tissue inflammation and central sensitization warrants their incorporation in pain management strategies for children. As the COX2 isoenzyme is the main target for controlling hyperalgesia, nonsteroidal anti-inflammatory drugs (NSAIDs) with high affinity for this enzyme will provide reliable antihyperalgesic effects. The benefits of NSAIDs for postsurgical pain therapy must be balanced against the risk of postoperative bleeding in children in whom any derangement of hemostasis could adversely affect outcome. If contraindications for NSAID use exist, paracetamol is the alternative. Paracetamol has potent antipyretic and analgesic effects, but no anti-inflammatory effect. The rectal route of administration is notoriously unreliable for eliciting an analgesic effect and the oral route is to be preferred. The dosage of paracetamol must take into account the pharmacokinetic properties of the drug in children. The maximum daily dosage should not be exceeded to avoid excessive production of a hepatotoxic metabolite.     

Nonsteroidal anti-inflammatory drugs and the risk of cardiovascular diseases

Non-steroidal anti-inflammatory drugs act as nonselective inhibitors of the enzyme cyclooxygenase (catalyzes the formation ofprostaglandins), inhibiting both the cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) isoenzymes. Selective COX-2 inhibitors have reduced gastrointestinal related adverse events but increased the risk of cardiovascular diseases. Selective COX-2 inhibitors may tip the natural balance between prothrombotic thromboxane A2 and antithrombotic prostacyclin potentially increasing the possibility of a thrombotic cardiovascular event. Decreased prostacycline synthesis, a vasodilatator and modulator of platelet activation, contributing to platelet aggregation and vasoconstriction. Some studies have suggested that NSAID increase the risk of cardiovascular events and for patients at high cardiovascular risk we should use them with great caution.     

Nonsteroidal anti-inflammatory drugs in the treatment of eosinophilic cystitis

A 30-year-old white woman with urinary frequency, left costovertebral angle pain and hematuria had left hydronephrosis, a marked decrease in bladder capacity and severe eosinophilic cystitis on biopsy. She was treated with a nonsteroidal anti-inflammatory drug and an antihistamine, with a dramatic, complete and rapid recovery. The nonsteroidal anti-inflammatory drug was believed to have been responsible for the favorable outcome, since antihistamines have not produced reliable benefits in this disease. Nonsteroidal anti-inflammatory drugs are recommended in cases of eosinophilic cystitis.     

The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on postoperative renal function: a meta-analysis

The aim of this systematic review was to assess the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on post-operative renal function. Eight randomized placebo-controlled double-blinded trials (n = 345) were identified from searches of MEDLINE, EMBASE and the Cochrane Controlled Trials Register databases. The summary effect size and 95% confidence intervals (95% CI) were calculated by a weighted mean difference analysis using a random-effects model. The NSAIDs (diclofenac, ketorolac, indomethacin, ibuprofen) were used for up to three-days after surgery. There were no reported cases of postoperative renal failure requiring dialysis. NSAIDs reduced creatinine clearance by 22 ml.min-1 (95% CI: 7 to 37), sodium output by 54 mmol.day-1 (95% CI: 5 to 103) and potassium output by 38 mmol.day-1 (95% CI: 19 to 56) on Day 1 but not on Day 2. Serum creatinine increased on Day 2 by 15 mumol.l-1 (95% CI: 2 to 28). Urine volume did not change significantly at any time. There was therefore a clinically unimportant transient reduction in renal function. NSAIDs should not be withheld from patients with normal preoperative renal function because of concerns about postoperative renal impairment.     

Nonsteroidal anti-inflammatory drugs and prostate cancer: a systematic review of the literature and meta-analysis

Prostate cancer is the most common visceral cancer in men. Many studies have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the risk of prostate cancer. We systematically searched all relevant databases (MEDLINE, EMBASE, The Cochrane Collaboration, CINAHL, Database of Abstracts of Review of Effects and ACP Journal Club) to March 2008. We also explored bibliographies of the articles, pertinent journals and conferences. We selected relevant articles according to predefined inclusion criteria by 2 independent reviewers. We used both fixed and random-effect models for meta-analysis. We performed subgroup and sensitivity analysis based on predefined variables. From 962 extracted articles, 20 met the inclusion criteria with a total of 25 768 participants. All the studies had an observational design. There was a statistically significant protective effect for NSAIDs on risk of prostate cancer (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.86–0.97). Subgroup analysis did not show any effect of study design or quality score on the results. There was a small but statistically significant protective effect for acetylsalicylic acid (ASA) (OR 0.95, 95% CI 0.91–1.00). Exposure to non-ASA NSAIDs was associated with a slightly reduced likelihood of prostate cancer (OR 0.92, 95% CI 0.85–1.00). With the available data, we were not able to determine an optimum dosage for NSAIDs. We conclude that taking NSAIDs may reduce the risk of prostate cancer. Nevertheless, the effect is small.     

Nonsteroidal antirheumatics and the kidney

The renal side effects of nonsteroidal anti-inflammatory drugs are very often and could be seen in 5% of patients who are treated with this drugs. These side effects could be separated in 5 clinical syndromes: 1. acute renal failure, 2. acute interstitial nephritis with nephrotic syndrome, 3. electrolyte and fluid disorders, 4. hypertension and 5. analgesic nephropathy. There are a lot data in the literature which suggest that selective COX-2 inhibitors (rofecoxib and celecoxib) produce the similar effects on the kidney as traditional nonsteroidal anti-inflammatory drugs (inhibitors of COX-1 and COX-2).     

Nonsteroidal anti-inflammatory drugs for prevention of heterotopic ossification after total hip arthroplasty

Nonsteroidal anti-inflammatory drugs (NSAID) have been proven highly effective as prophylaxis for periarticular heterotopic ossification (HO) following total hip arthroplasty (THA) both when given to patients considered to be at risk for this complication, and in consecutive double-blind studies. Treatment with a standard dosage for 10 days starting on the day of surgery seems to be adequate for the prophylactic effect. Furthermore, NSAID are effective in preventing recurrence of HO after resection.     

Nonsteroidal anti-inflammatory drugs attenuate epidermal growth factor-induced proliferation independent of prostaglandin synthesis inhibition.

BACKGROUND: The mechanism(s) whereby nonsteroidal anti-inflammatory drugs (NSAIDs) attenuate colorectal tumor growth remains poorly understood. This study determined if NSAIDs decreased epidermal growth factor (EGF)-induced proliferation in human colonic tumor (Caco-2) cells and whether this process involved the inhibition of prostaglandin (PG) synthesis. METHODS: Caco-2 cells were serum-starved (48 h) and subsequently treated (48 h) with either serum-free media or EGF (10 ng/ml) +/- physiologic and noninjurious (as determined by LDH release) concentrations of aspirin, indomethacin, and ibuprofen. PG synthesis was measured by EIA. Proliferation was quantitated with two assays: cellular protein and nucleic acid content. RESULTS: NSAID treatment did not inhibit growth in cells treated with only serum-free media. Cells exposed to EGF demonstrated a significant increase in PGE2, protein, and nucleic acid. Levels of other eicosanoids (PGI2, TXA2) were minimal both before and after EGF treatment. Despite varying degrees of PGE2 inhibition, each NSAID group equally attenuated EGF-induced protein and nucleic acid synthesis. The correlation between PGE2 levels and protein (R2 = 0.56) or nucleic acid (R2 = 0.54) was poor. Finally, the addition of a physiologically appropriate concentration of exogenous PGE2 failed to reverse NSAID-induced growth inhibition. CONCLUSION: These data suggest that NSAIDs, independent of PG synthesis inhibition, attenuate EGF-induced proliferation in Caco-2 cells. This may provide one explanation for how NSAIDs limit colonic neoplasia.     

The role of viscosupplementation with hylan G-F 20 (Synvisc®) in the treatment of osteoarthritis of the knee: a Canadian multicenter trial comparing hylan G-F 20 alone, hylan G-F 20 with non-steroidal anti-inflammatory drugs (NSAIDs) and NSAIDs alone

To determine the safety and efficacy of viscosupplementation with hylan G-F 20, a cross-linked hyaluronan preparation, used either alone or in combination with continuous non-steroidal anti-inflammatory drug (NSAID) therapy, a randomized, controlled, multicenter clinical trial, assessed by a blinded assessor, was conducted in 102 patients with osteoarthritis (OA) of the knee. All patients were on continuous NSAID therapy for at least 30 days prior to entering the study. Patients were randomized into three parallel groups: (1) NSAID continuation plus three control arthrocenteses at weekly intervals; (2) NSAID discontinuation but with three weekly intra-articular injections of hylan G-F 20; and (3) NSAID continuation plus three injections, one every week, intra-articular injections of hylan G-F 20. Outcome measures of pain and joint function were evaluated by both the patients and an evaluator at baseline and weeks 1, 2, 3, 7 and 12, with a follow-up telephone evaluation at 26 weeks. At 12 weeks all groups showed statistically significant improvements from baseline, but did not differ from each other. A statistical test for equivalence, the q-statistic, demonstrated that viscosupplementation with hylan G-F 20 was at least as good or better than continuous NSAID therapy for all outcome measurements except activity restriction. At 26 weeks both groups receiving hylan G-F 20 were significantly better than the group receiving NSAIDs alone. A transient local reaction was observed in three patients after hylan G-F 20 injection; only one patient withdrew from the study as a result and all recovered without any sequela.Hylan G-F 20 is a safe and effective treatment for OA of the knee and can be used either as a replacement for or an adjunct to NSAID therapy.