Kelley Brian P, Bennett Katelyn G, Chung Kevin C, Kozlow Jeffrey H
Ann Arbor, Mich.
From the Section of Plastic and Reconstructive Surgery, University of Michigan Health System, and the University of Michigan Medical School.
Plast Reconstr Surg. 2016 Apr;137(4):1309-1316. doi: 10.1097/PRS.0000000000002027.
Nonsteroidal antiinflammatory drugs such as ibuprofen are common medications with multiple useful effects, including pain relief and reduction of inflammation. However, surgeons commonly withhold all nonsteroidal antiinflammatory drugs perioperatively because of bleeding concerns. However, not all nonsteroidal antiinflammatory drugs irreversibly block platelet function. The authors hypothesized that the use of ibuprofen would have no effect on postoperative bleeding in plastic surgery patients.
A literature review was performed using MEDLINE (PubMed), EMBASE, and the Cochrane Collaboration Library for primary research articles on ibuprofen and bleeding. Inclusion criteria were primary journal articles examining treatment of acute postoperative pain based on any modality. Data related to pain assessment, postoperative recovery, and complications were extracted. Bias assessment and meta-analysis were performed.
A total of 881 publications were reviewed. Four primary randomized controlled trials were selected for full analysis. Articles were of high quality by bias assessment. No significant difference was noted regarding bleeding events (p = 0.32), and pain control was noted to be equivalent.
Ibuprofen is a useful medication in the setting of surgery, with multiple beneficial effects. This meta-analysis represents a small set of high-quality studies suggesting that ibuprofen provides pain control equivalent to narcotics. Importantly, ibuprofen was not associated with an increased risk of bleeding. Further large studies will be necessary to elucidate this issue further, but ibuprofen is a safe postoperative analgesic in patients undergoing common plastic surgery soft-tissue procedures.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
布洛芬等非甾体类抗炎药是常用药物，具有多种有益作用，包括缓解疼痛和减轻炎症。然而，由于担心出血问题，外科医生通常在围手术期停用所有非甾体类抗炎药。然而，并非所有非甾体类抗炎药都会不可逆地阻断血小板功能。作者推测，使用布洛芬对整形外科患者的术后出血没有影响。
使用MEDLINE（PubMed）、EMBASE和Cochrane协作图书馆进行文献综述，以查找关于布洛芬与出血的原发性研究文章。纳入标准为基于任何方式检查急性术后疼痛治疗的原发性期刊文章。提取与疼痛评估、术后恢复和并发症相关的数据。进行偏倚评估和荟萃分析。
共检索了881篇出版物。选择了四项原发性随机对照试验进行全面分析。通过偏倚评估，文章质量较高。在出血事件方面未发现显著差异（p = 0.32），且疼痛控制效果相当。
布洛芬在手术环境中是一种有用的药物，具有多种有益作用。这项荟萃分析代表了一小部分高质量研究，表明布洛芬提供的疼痛控制效果与麻醉剂相当。重要的是，布洛芬与出血风险增加无关。需要进一步进行大型研究以进一步阐明这个问题，但布洛芬对于接受常见整形外科软组织手术的患者来说是一种安全的术后镇痛药。
临床问题/证据水平：治疗性，II级。
