Should nonselective nonsteroidal anti-inflammatory drugs be avoided following dermatological surgery? A critically appraised topic with a proposed approach to postoperative analgesia

摘要

Nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are often avoided by dermatological surgeons from the historic teaching that they increase postoperative bleeding (POB) through inhibition of platelet aggregation. NSAIDs have two classes: nonselective cyclooxygenase (C0X)2 inhibitors, which inhibit all COX enzymes and selective C0X2 inhibitors. Nonselective NSAIDs increase bleeding time by inhibition of the COX1 enzyme, resulting in decreased levels of thromboxane A_2, a vasoconstrictor that is vital for platelet aggregation. COX2 inhibitors act differently and pose no bleeding risk. Aspirin inhibits the enzyme irreversibly for the platelet's lifetime. Other NSAIDs are reversible, with effects dependent on dose and half-life. We critically appraised the evidence assessing the effect of nonselective NSAIDs (excluding aspirin) on POB from peer-reviewed randomized controlled trials (RCTs). We propose an approach to postoperative pain following dermatological procedures (Fig. 1, Table 1).