The Impact of Nonsteroidal Anti-inflammatory Drugs on Older Adult Trauma Patients With Hip Fractures

Haines, Krista; Fuller, Matthew; Vaughan, Justin; Krishnamoorthy, Vijay; Raghunathan, Karthik; Kasotakis, George; Agarwal, Suresh; Ohnuma, Tetsu

doi:10.1016/j.jss.2020.05.064

Cited by 12 publications

(17 citation statements)

References 45 publications

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“…26 In a cohort of geriatric trauma patients over a 6-year period, these drugs were associated with decreased opioid requirements without an overall increase in bleeding. 27 We generally avoid nonsteroidal anti-infl ammatory drugs in patients with preexisting renal dysfunction.…”

Section: Pain Controlmentioning

confidence: 99%

Update on medical management of acute hip fracture

Ackermann

Schwenk

Lev

et al. 2021

CCJM

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H ip fractures are the most common reason for urgent surgery in the elderly and often lead to long-term institutional care. 1 Despite advances in perioperative management, postoperative mortality rates remain high, up to 10% in the fi rst 30 days and 8% to 36% in the fi rst year after repair. 2 Even 10 years after fracture repair, the mortality rate due to comorbid medical conditions remains higher than in age-matched controls. 3

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Section: Pain Controlmentioning

confidence: 99%

Update on medical management of acute hip fracture

Ackermann

Schwenk

Lev

et al. 2021

CCJM

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“…In a cohort study of >190,000 geriatric adults admitted with traumatic hip fracture, day-of-surgery NSAID administration was associated with decreased opioid consumption, pulmonary complications, intensive care unit (ICU) admission, and hospital LOS with no increased incidence of acute renal insufficiency or postoperative transfusion requirement. 41 Parecoxib (40 mg IV, cyclooxygenase-2 [COX-2] selective NSAID not approved in the United States) administered 30 minutes before surgery reduced pain scores in the recovery room compared with saline in an RCT of patients (mean age 66 years) undergoing total knee arthroplasty (TKA). 21 Finally, an RCT of geriatric adults undergoing TKA found preoperative meloxicam therapy (preferential COX-2 inhibitor) to decrease postoperative pain scores at rest (6, 12, and 24 hours) and with flexion (6, 12, 24, and 48 hours) compared to patients starting meloxicam after surgery.…”

Section: Nonopioid Analgesics Commonly Prescribed Throughout the Peri...mentioning

confidence: 99%

Nonopioid Analgesics for the Perioperative Geriatric Patient: A Narrative Review

Wilson

Bridges

et al. 2022

Anesthesia &Amp; Analgesia

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Management of acute perioperative pain in the geriatric patient can be challenging as the physiologic and pharmacokinetic changes associated with aging may predispose older patients to opioid-related side effects. Furthermore, elderly adults are more susceptible to postoperative delirium and postoperative cognitive dysfunction, which may be exacerbated by both poorly controlled postoperative pain and commonly used pain medications. This narrative review summarizes the literature published in the past 10 years for several nonopioid analgesics commonly prescribed to the geriatric patient in the perioperative period. Nonopioid analgesics are broken down as follows: medications prescribed throughout the perioperative period (acetaminophen and nonsteroidal antiinflammatory drugs), medications limited to the acute perioperative setting (N-methyl-D-aspartate receptor antagonists, dexmedetomidine, dexamethasone, and local anesthetics), and medications to be used with caution in the geriatric patient population (gabapentinoids and muscle relaxants). Our search identified 1757 citations, but only 33 specifically focused on geriatric analgesia. Of these, only 21 were randomized clinical trials‚ and 1 was a systematic review. While guidance in tailoring pain regimens that focus on the use of nonopioid medications in the geriatric patient is lacking, we summarize the current literature and highlight that some nonopioid medications may extend benefits to the geriatric patient beyond analgesia. (Anesth Analg 2022;135:290-306) GLOSSARY AChEI = acetylcholinesterase inhibitor; AGS = American Geriatric Society; ALT = alanine aminotransferase; ANS = autonomic nervous system; AV = atrioventricular; CBF = cerebral blood flow; CINAHL = Cumulative Index to Nursing and Allied Health Literature; C max = maximum plasma concentration; CNS = central nervous system; COX = cyclooxygenase; CVA = cerebrovascular accident; ED = effective dose; ER = extended release; FDA = US Food and Drug Administration; GABA = gamma-aminobutyric acid; GFR = glomerular filtration rate; GI = gastrointestinal; ICU = intensive care unit; IM = intramuscular; IR = immediate release; IV = intravenous; LOS = length of stay; MA = meta-analysis; MAOIs = monoamine oxidase inhibitors; MeSH = Medical Subject Heading; MI = myocardial ischemia; NAPQI = N-acetyl-p-benzoquinone imine; NMDA = N-methyl-d-aspartate; NO = nitric oxide; NSAIDs = nonsteroidal anti-inflammatory drugs; PGE2 = prostaglandin E2; POCD = postoperative cognitive dysfunction; POD = postoperative day; PONV = postoperative nausea and vomiting; PPI = proton pump inhibitor; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RBF = renal blood flow; RCT = randomized controlled trial; SA = sinoatrial; SAH = subarachnoid hemorrhage; SE = side effects; T 1/2 = half-life; TKA = total knee arthroplasty; V d = volume of distribution Chronic Pain Medicine E NArrAtiVe reView Article

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“…Non-steroidal anti-inflammatory drugs (NSAIDs) are effective analgesia and may reduce postoperative opioid requirements and length of stay for older patients. 60 Careful judgement is required given the risks, including cardiac ischaemia, renal injury, and peptic ulceration. 61 Prolonged use in older patients prior to orthopaedic surgery is also associated with increased perioperative transfusion requirement.…”

Section: Non-steroidal Anti-inflammatory Drugsmentioning

confidence: 99%

“…Non‐steroidal anti‐inflammatory drugs (NSAIDs) are effective analgesia and may reduce postoperative opioid requirements and length of stay for older patients 60 . Careful judgement is required given the risks, including cardiac ischaemia, renal injury, and peptic ulceration 61 .…”

Section: Medication Management Of Postoperative Pain Constipation And...mentioning

confidence: 99%

Perioperative medication management for older people

Johnson

Haywood

2022

Pharmacy Practice and Res

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The average age of surgical candidates is increasing with the ageing population worldwide. Major surgery in older patients is associated with a significant risk of complications due to physiologic changes occurring with ageing and individual patient factors such as frailty, polypharmacy, and multimorbidity. Periodic medication review should be part of the routine management of all older patients, with the perioperative period presenting an opportune time for this review. Regular medications may need short-term modification during the surgical period. Medications implicated in increasing risk of inducing or worsening delirium should be identified and withdrawal considered ahead of time. Perioperative commencement of medication aimed at reducing risk of other complications, including cardiovascular events, should be considered on an individual basis, analysing risks and benefits. Comprehensive medication review and careful planning through the perioperative period may enhance the prospects of recovery and reduce morbidity and mortality for older surgical patients.

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The Impact of Nonsteroidal Anti-inflammatory Drugs on Older Adult Trauma Patients With Hip Fractures

Cited by 12 publications

References 45 publications

Update on medical management of acute hip fracture

Update on medical management of acute hip fracture

Nonopioid Analgesics for the Perioperative Geriatric Patient: A Narrative Review

Perioperative medication management for older people

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