trointestinal and renal complications. However, research has shown
that those complications tend to be a result of long-term administra-
tion of higher doses, typically for more than 5 days. There's also con-
cern that the use of non-selective NSAIDs can cause increased opera-
tive site bleeding, but studies have found that that typically only
applies to surgical procedures involving "raw" surface areas like tonsil-
lectomies and plastic surgery. To avoid this complication, have your
staff give the first dose of the NSAID after the surgeon has achieved
hemostasis or in PACU.
A selective category of NSAIDs, called COX-2 inhibitors, targets only
the COX-2 enzyme that stimulates the inflammatory response in the
body. You may want to consider this class of NSAIDs for certain at-
risk patients, since it causes fewer stomach problems and has a lower
risk of perioperative bleeding.
The dwindling use of opioids
Ideally, your plan should include opioids only as "rescue" medications.
That means the use of an oral opioid in combination with an NSAID
5 5
A P R I L 2 0 1 5 | O U T P A T I E N T S U R G E R Y . N E T
z A BALANCED APPROACH Combining nerve blocks with NSAIDs
and IV acetaminophen can give you a superior pain management plan.
