RT Journal Article
SR Electronic
T1 Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma and the Orthopedic Trauma Association
JF Trauma Surgery & Acute Care Open
JO Trauma Surg Acute Care Open
FD BMJ Publishing Group Ltd
SP e001056
DO 10.1136/tsaco-2022-001056
VO 8
IS 1
A1 Patrick B Murphy
A1 George Kasotakis
A1 Elliott R Haut
A1 Anna Miller
A1 Edward Harvey
A1 Eric Hasenboehler
A1 Thomas Higgins
A1 Joseph Hoegler
A1 Hassan Mir
A1 Sarah Cantrell
A1 William T Obremskey
A1 Meghan Wally
A1 Basem Attum
A1 Rachel Seymour
A1 Nimitt Patel
A1 William Ricci
A1 Jennifer J Freeman
A1 Krista L Haines
A1 Brian K Yorkgitis
A1 Brandy B Padilla-Jones
YR 2023
UL http://tsaco.bmj.com/content/8/1/e001056.abstract
AB Objectives Fracture is a common injury after a traumatic event. The efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) to treat acute pain related to fractures is not well established.Methods Clinically relevant questions were determined regarding NSAID use in the setting of trauma-induced fractures with clearly defined patient populations, interventions, comparisons and appropriately selected outcomes (PICO). These questions centered around efficacy (pain control, reduction in opioid use) and safety (non-union, kidney injury). A systematic review including literature search and meta-analysis was performed, and the quality of evidence was graded per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The working group reached consensus on the final evidence-based recommendations.Results A total of 19 studies were identified for analysis. Not all outcomes identified as critically important were reported in all studies, and the outcome of pain control was too heterogenous to perform a meta-analysis. Nine studies reported on non-union (three randomized control trials), six of which reported no association with NSAIDs. The overall incidence of non-union in patients receiving NSAIDs compared with patients not receiving NSAIDs was 2.99% and 2.19% (p=0.04), respectively. Of studies reporting on pain control and reduction of opioids, the use of NSAIDs reduced pain and the need for opioids after traumatic fracture. One study reported on the outcome of acute kidney injury and found no association with NSAID use.Conclusions In patients with traumatic fractures, NSAIDs appear to reduce post-trauma pain, reduce the need for opioids and have a small effect on non-union. We conditionally recommend the use of NSAIDs in patients suffering from traumatic fractures as the benefit appears to outweigh the small potential risks.All data relevant to the study are included in the article.