Walker Nicholas J, Jones Veronica M, Kratky Lauren, Chen Haiying, Runyan Christopher M
From the Departments of Plastic and Reconstructive Surgery and.
General Surgery, Wake Forest Baptist Health.
Ann Plast Surg. 2019 Jun;82(6S Suppl 5):S437-S445. doi: 10.1097/SAP.0000000000001898.
The opioid crisis in America has sparked a shift toward a multimodality perioperative pain regimen. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the perioperative period decreases opioid consumption and increases efficacy. However, many plastic surgeons avoid their use because of antiplatelet effects. The purpose of this article is to systematically review the plastic surgery literature to assess the risk of intraoperative or postoperative bleeding and hematoma formation.
A systematic review of articles published in PubMed was performed in September 2018 to investigate the incidence of increased bleeding and hematoma formation with use of NSAIDs in the perioperative period in plastic surgery. All articles were reviewed for primary outcome measures, and a selective literature review was performed to examine perioperative NSAID use in other surgical subspecialties. Random-effect meta-analysis was performed.
Our search yielded 806 total articles, with 15 meeting inclusion criteria, and this included 3064 patients (1679 with perioperative NSAIDs, 1385 with no NSAIDs). There was no significant difference in overall incidence of bleeding/hematoma in the treatment group versus control (no NSAIDs). The overall pooled odds ratio (OR) and corresponding 95% confidence interval were 1.20 and 0.73 to 1.97 (P = 0.48). When separated by drug administered across all plastic surgery procedures, there were no statistically significant differences in incidences of hematoma or increased bleeding with use of ketorolac (OR, 1.48 [0.86-2.56]; P = 0.57), ibuprofen (OR, 0.55 [0.14-2.14]; P = 0.87), or celecoxib (OR, 0.22 [0.02-2.52]; P = 0.39). When examining NSAID use in breast surgery, there was no statistically significant difference in incidence of hematoma or increased bleeding when combining all 3 drug types (OR, 1.39 [0.82-2.37]; P = 0.60). Some individual studies demonstrated trends toward increased bleeding/hematoma in reduction mammoplasties.
Nonsteroidal anti-inflammatory drugs significantly improve pain control and decrease opioid use when used in plastic surgery. The majority of evidence in plastic surgery does not support an increased incidence of bleeding/hematoma with the use of perioperative NSAIDs.
美国的阿片类药物危机引发了围手术期疼痛管理模式向多模式转变。围手术期使用非甾体类抗炎药（NSAIDs）可减少阿片类药物的用量并提高疗效。然而，许多整形外科医生因抗血小板作用而避免使用此类药物。本文旨在系统回顾整形外科文献，以评估术中或术后出血及血肿形成的风险。
2018年9月对发表在PubMed上的文章进行系统回顾，以调查整形外科围手术期使用NSAIDs后出血增加及血肿形成的发生率。对所有文章的主要结局指标进行审查，并进行选择性文献回顾，以研究其他外科亚专业围手术期NSAIDs的使用情况。进行随机效应荟萃分析。
我们的检索共得到806篇文章，其中15篇符合纳入标准，共纳入3064例患者（1679例围手术期使用NSAIDs，1385例未使用）。治疗组与对照组（未使用NSAIDs）的出血/血肿总发生率无显著差异。总体合并优势比（OR）及相应的95%置信区间为1.20和0.73至1.97（P = 0.48）。在所有整形外科手术中按所用药物分类，使用酮咯酸（OR，1.48 [0.86 - 2.56]；P = 0.57）、布洛芬（OR，0.55 [0.14 - 2.14]；P = 0.87）或塞来昔布（OR，0.22 [0.02 - 2.52]；P = 0.39）时，血肿或出血增加的发生率无统计学显著差异。在乳腺手术中研究NSAIDs的使用时，将所有三种药物类型合并使用时，血肿或出血增加的发生率无统计学显著差异（OR，1.39 [0.82 - 2.37]；P = 0.60）。一些个别研究显示在乳房缩小成形术中出血/血肿有增加的趋势。
非甾体类抗炎药在整形外科中使用时可显著改善疼痛控制并减少阿片类药物的使用。整形外科的大多数证据不支持围手术期使用NSAIDs会增加出血/血肿的发生率。
