Paracetamol
- Paracetamol given pre- and intraoperatively reduces PONV and improves analgesia, but does ont reduce opioids
- Reduces PONV when given IV
Effect is independent of its reduction in opioid requirements.
NSAIDs
- Renal injury is low when used appropriately
- All NSAIDs sit on a spectrum of activity between COX-1 and COX-2
- Non-selective NSAIDs:
- Are associated with ↑ risk of minor and major bleeding
- May precipitate bronchospasm in susceptible patients
- COX-2 inhibitors do not:
- Impair platelet function
Blood loss is reduced compared to non-selective NSAIDs and comparable to placebo after TKR.
- Precipitate bronchospasm
- Appear to ↑ rates of gastric ulceration when used in short courses (5-7 days)
- Affect bone healing in humans
- Cardiac risk is:
- Slightly greater with COX-2s
- Appears dose-related
- ↑ in patients without diagnosed cardiac disease
- Naproxen and celecoxib have lower risks of myocardial injury than other NSAIDs
References
- Schug SA, Palmer GM, Scott DA, Alcock M, Halliwell R, Mott JF; APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine (2020), Acute Pain Management: Scientific Evidence (5th edition), ANZCA & FPM, Melbourne.