lar risks.
Still, there are some potentially significant side effects to consider.
The primary contraindication is patients who have renal disease. The
IV NSAIDs all affect renal function. And it's important to be aware
that hypovolemia worsens the effects. Otherwise-healthy patients who
are given NSAIDs may have renal failure if they're hypovolemic.
There's also an anti-platelet effect, so there's some concern about
the potential for bleeding. Gastrointestinal erosion is another concern.
You don't want to use IV NSAIDs on patients who have a history of GI
bleeds or who have had bariatric surgery.
While it's been suggested that bone healing can be impaired by
NSAIDs, that concern seems to be falling by the wayside. More and more
surgeons are using NSAIDs during spinal fusions and fracture repairs,
and they're being widely used for joint replacements, without any evi-
dence of impairment. Their effect on soft tissue healing has also been
called into question, but that concern has clearly been shown to be
invalid.
Moving forward
If you've already embraced the concept of multimodal analgesia —
and thankfully, more and more are embracing it all the time — IV
NSAIDs provide a great starting point that's completely under your
control and that you can extend from pre-operative to intraoperative
to post-operative care.
While IV acetaminophen (Ofirmev) is not in the NSAID class, it, too,
can have an additive effect with NSAIDs, further reducing pain and
opioid requirements. As an IV agent, it shares the utility of the other
intravenously administered drugs.
Concerns about opioids are legitimate and they're growing.
Regulators are establishing new guidelines, and the discussion has
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