Fernando-Canavan Liam T A, Stanny Alistair, Richmond John, Mitchell David J
Grampians Health Ballarat, Orthopaedic Unit, Ballarat, Victoria, Australia.
Health Economics and Simulation Modelling for Chronic Disease Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
ANZ J Surg. 2025 Jul-Aug;95(7-8):1553-1559. doi: 10.1111/ans.70261. Epub 2025 Jul 25.
Non-steroidal anti-inflammatory drugs (NSAIDs) are fundamental for multimodal analgesic therapy, but are traditionally avoided in renally impaired patients. We aim to show NSAIDs can be safely administered to arthroplasty patients with a pre-operative estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m without causing a permanent reduction in post-operative eGFR and, in doing so, minimise opioid use.
We prospectively collected data from patients with a pre-operative eGFR less than 60 mL/min/1.73 m undergoing arthroplasty between January 2018 and June 2023 at St John of God Ballarat Hospital, Australia. Baseline eGFR was obtained pre-operatively, and on at least 1 of days 1, 2, 10, or a follow-up review appointment of at least 4 weeks. Patients received tailored dosing of perioperative NSAIDs corresponding to pre-operative eGFR. Acute kidney injury (AKI) was defined using the RIFLE criteria.
We identified 221 patients. Median baseline eGFR was 50 mL/min/1.73 m and median eGFR recovery at latest follow-up was 109% of baseline eGFR. 28% of the cohort had a clinically significant reduction in eGFR on day 1 post-operatively, and by latest follow-up, this subgroup had a median recovery of 106% of baseline eGFR. At the 2-week follow-up, there were no cases of AKI, and by latest follow-up, no patients had a clinically significant reduction of baseline eGFR.
Perioperative NSAIDs in renally impaired patients undergoing arthroplasty surgery can be safely given using an adjusted dose protocol based on pre-operative renal function. Future studies investigating the circumspect use of NSAIDs for pain management during arthroplasty are warranted.
非甾体类抗炎药（NSAIDs）是多模式镇痛治疗的基础，但传统上肾功能受损患者应避免使用。我们旨在表明，对于术前估计肾小球滤过率（eGFR）低于60 mL/min/1.73 m²的关节置换患者，NSAIDs可以安全给药，且不会导致术后eGFR永久性降低，从而尽量减少阿片类药物的使用。
我们前瞻性收集了2018年1月至2023年6月在澳大利亚巴拉瑞特上帝医院接受关节置换手术、术前eGFR低于60 mL/min/1.73 m²的患者的数据。术前获得基线eGFR，并在术后第1天、第2天、第10天或至少4周的随访复查中至少有1天获取。患者接受根据术前eGFR调整的围手术期NSAIDs剂量。急性肾损伤（AKI）采用RIFLE标准定义。
我们纳入了221例患者。基线eGFR中位数为50 mL/min/1.73 m²，最新随访时eGFR恢复中位数为基线eGFR的109%。28%的队列在术后第1天eGFR出现临床显著降低，到最新随访时，该亚组恢复中位数为基线eGFR的106%。在2周随访时，无AKI病例，到最新随访时，无患者基线eGFR出现临床显著降低。
对于接受关节置换手术的肾功能受损患者，围手术期NSAIDs可以根据术前肾功能采用调整剂量方案安全给药。有必要开展进一步研究，探讨在关节置换术中谨慎使用NSAIDs进行疼痛管理的情况。
