Despite the numerous high and moderate quality randomized clinical trials investigating administration of oral NSAIDs during the perioperative period, such as preoperatively or during the postoperative admission, we lack the same level of evidence to evaluate the use of oral NSAIDs after discharge. Because of concerns regarding the safety of non-selective oral NSAID administration for an extended duration and lack of specific evidence for non-selective oral NSAIDs after discharge, the workgroup has elected to only make a recommendation regarding the use of selective oral NSAIDs after discharge from a primary TJA.
Similar to the administration of oral selective COX-2 (includes selective [i.e. Celecoxib] and preferential [i.e. Meloxicam] COX-2 inhibitory agents) NSAIDs during the perioperative period, such as preoperatively or during the postoperative admission, utilization of an extended duration of oral selective COX-2 NSAIDs reduces the postoperative pain and opioid consumption. A single high quality study investigating the administration of an oral selective COX-2 NSAID compared to placebo for six-weeks provides overwhelming evidence favoring oral selective COX-2 NSAID use following a primary TKA. Because we lack similar evidence after a primary THA, the workgroup provides a consensus recommendation favoring the administration of an oral selective COX-2 NSAID after discharge from primary THA. Furthermore, the inclusion of an oral NSAID as a component of a postoperative multimodal pain management protocol following primary TJA has demonstrated a reduction in pain, opioid consumption, and the risk of opioid-related adverse effects, such as respiratory depression, nausea/vomiting, sedation, or urinary retention. Therefore, we can support the use of oral selective COX-2 NSAIDs after discharge from a primary TJA as part of a multimodal pain regimen.
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- Memtsoudis SG, Poeran J, Zubizarreta N, Cozowicz C, Morwald EE, Mariano ER, Mazumdar M. Association of Multimodal Pain Management Strategies with Perioperative Outcomes and Resource Utilization: A Population-based Study. Anesthesiology 128(5): 891-902, 2018 DOI: 10.1097/ALN.0000000000002132