2023EAST／OTA实践管理指南：非甾体抗炎药(NSAIDs)治疗骨科创伤后急性疼痛的疗效和安全性

Open accessSystematic reviewTrauma SurgeryAcute Care OpenEfficacy and safety of non-steroidal anti-inflammatorydrugs(NSAIDs)for the treatment of acute pain afterorthopedic trauma:a practice management guidelinefrom the Eastern Association for the Surgery ofTrauma and the Orthopedic Trauma AssociationPatrick B Murphy,George Kasotakis,2 Elliott R Haut,Anna Miller,4Edward Harvey,s Eric Hasenboehler,Thomas Higgins,?Joseph Hoegler,Hassan Mir,Sarah Cantrell,10 William T Obremskey,1 Meghan Wally,12 Basem Attum,3Rachel Seymour,12 Nimitt Patel14 William Ricci,15 Jennifer J Freeman6Krista L Haines,Brian K Yorkgitis,7 Brandy B Padilla-JonessAdditional supplementalABSTRACTmaterial is published onlineObjectives Fracture is a common injury after aWHAT IS ALREADY KNOWN ON THIS TOPIConly.To view,please visit thetraumatic event.The efficacy and safety of non-steroidalThe use of non-steroidal anti-inflammatoryjoumal online (http://dx.doi0rg10.1136/tsc0-2022-anti-inflammatory drugs(NSAIDs)to treat acute paindrugs (NSAIDs)for analgesia after traumatic001056.related to fractures is not well established.fracture is inconsistent and controversial dueMethods Clinically relevant questions were detemminedto uncertainty about the balance of hamFor numbered affiliations seeregarding NSAID use in the setting of trauma-induced(non-union)and benefit(analgesia and opioidend of article.fractures with dearly defined patient populations,reduction).interventions,comparisons and appropriately selectedWHAT THIS STUDY ADDSCorrespondence toDr Patrick B Murphy;outcomes(PICO).These questions centered around efficacyNSAIDs have a clear analgesic and opioidpbatesmurphy@gmail.com(pain control reduction in opioid use)and safety(non-union,reduction effect with a minimal increase in non-kidney injury).A systematic review including literatureReceived 7 November 2022union when prescribed to patients with acutesearch and meta-analysis was performed,and the quality ofAccepted 9 January 2023traumatic fractures.evidence was graded per the Grading of RecommendationsHOW THIS STUDY MIGHT AFFECT RESEARCH,Assessment,Development and Evaluation(GRADE)PRACTICE OR POLICYmethodology.The working group reached consensus on thefinal evidence-based recommendations.The benefits of NSAIDs in the treatment ofResults A total of 19 studies were identified for analysis.acute traumatic fracture outweigh the potentialNot all outcomes identified as critically important wereharms.reported in all studies,and the outcome of pain controlwas too heterogenous to perform a meta-analysis.Ninestudies reported on non-union(three randomized controllast three decades,drug overdoses,largely due totrials),six of which reported no association with NSAIDs.Theopioids,have tripled.This public health crisis hasoverall incidence of non-union in patients receiving NSAIDsled providers to consider alternative pharmaceuti-compared with patients not receiving NSAIDs was 2.99%cals to control pain after trauma.Therefore,thereand 2.19%(p=0.04),respe