Risk of serious adverse events associated with non‐steroidal anti‐inflammatory drugs in orthopaedic surgery. A protocol for a systematic review

• Published in: Acta anaesthesiologica Scandinavica Vol. 66; no. 10; pp. 1257 - 1265
• Main Authors: Leth, Morten Fiil, Bukhari, Shaheer, Laursen, Christina Cleveland Westerdahl, Larsen, Mia Esta, Tornøe, Anders Schou, Jakobsen, Janus Christian, Maagaard, Mathias, Mathiesen, Ole
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-11-2022; John Wiley and Sons Inc
• Subjects: Adverse events; Analgesics; Analgesics - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Clinical trials; Health services; Humans; Inflammation; Meta-analysis; Meta-Analysis as Topic; Nonsteroidal anti-inflammatory drugs; NSAID; Orthopedic Procedures - adverse effects; Orthopedics; Pain; Pain, Postoperative - chemically induced; Pain, Postoperative - drug therapy; Patients; Quality assessment; Quality of Life; Rehabilitation; Review; Risk assessment; Sequential analysis; serious adverse events; Special; Surgery; Systematic review; Systematic Reviews as Topic; serious adverse events; systematic review; NSAID
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/aas.14140

Background
Postoperative pain is a common condition following orthopaedic surgeries and causes prolonged hospitalisation, delayed rehabilitation and hamper the quality of life. Non‐steroidal anti‐inflammatory drugs (NSAIDs) are effective analgesics and anti‐inflammatory mediators in the treatment of postoperative pain. The association of NSAIDs with serious adverse events may however keep some clinicians and clinical decision makers from using NSAIDs perioperatively. The evidence regarding the risks of serious adverse events following perioperative use of NSAIDs in orthopaedic surgery is sparse and needs to be assessed in a systematic review. This is a protocol for a systematic review that aims to identify the risks of serious adverse events from perioperative use of NSAIDs in orthopaedic patients.
Methods
Our methodology is based on the Preferred Reporting Items for Systematic Review and Meta‐Analysis Protocols and the eight‐step assessment procedure suggested by Jakobsen and colleagues. We wish to assess if NSAIDs versus placebo, usual care or no intervention, will influence the risks of serious adverse events in patients undergoing orthopaedic surgery. We will include all randomised trials assessing the use of NSAIDs perioperatively. To identify trials we will search the Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cochrane Central Register, Science Citation Index Expanded on Web of Science and BIOSIS. Two authors will screen the literature and extract data. We will use the ‘Risk of Bias 2 tool’ to assess trials. Extracted data will be analysed using RStudio and Trial Sequential Analysis. We will create a ‘Summary of Findings’ table in which we will present our primary and secondary outcomes. We will assess the quality of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Discussion
This systematic review can potentially aid clinicians and clinical decision makers in the use of NSAIDs for treatment of postoperative pain following orthopaedic surgeries.