Page 23 Acute Pain Management

11. Non‐selective NSAIDs and coxibs are effective analgesics of similar efficacy for acute pain
(U) (Level I).
12. Preoperative coxibs reduce postoperative pain and opioid consumption, and increase
patient satisfaction (N) (Level I).

13. Coxibs given in addition to PCA opioids reduce opioid consumption but do not result in a
decrease in opioid‐related side effects (N) (Level I).
14. Coxibs and non‐selective NSAIDs have similar adverse effects on renal function (U)
(Level I).
15. Non‐selective NSAIDs do not significantly increase blood loss after tonsillectomy but do
increase the need for reoperation due to bleeding (N) (Level I).
16. Parecoxib and/or valdecoxib compared with placebo do not increase the risk of SUMMARY
cardiovascular adverse events after non‐cardiac surgery (N) (Level I).
17. Coxibs and non‐selective NSAIDs are associated with similar rates of adverse
cardiovascular effects, in particular myocardial infarction; naproxen may be associated
with a lower risk than other non‐selective NSAIDs and celecoxib may be associated with a
lower risk than other coxibs and non‐selective NSAIDs overall (N) (Level I).

18. Perioperative non‐selective NSAIDs increase the risk of severe bleeding after a variety of
other operations compared with placebo (N) (Level II).
19. Coxibs do not impair platelet function; this leads to reduced perioperative blood loss in
comparison with non‐selective NSAIDs (S) (Level II).
20. Short‐term use of coxibs results in gastric ulceration rates similar to placebo (U) (Level II).
21. Use of parecoxib followed by valdecoxib after coronary artery bypass surgery increases
the incidence of cardiovascular events and is therefore contraindicated (S) (Level II).
 Adverse effects of NSAIDs are significant and may limit their use (U).
 The risk of adverse renal effects of non‐selective NSAIDs and coxibs is increased in the
presence of factors such as pre‐existing renal impairment, hypovolaemia, hypotension,
use of other nephrotoxic agents and ACE inhibitors (U).

Adjuvant drugs
Inhalational agents
1. Nitrous oxide has some analgesic efficacy and is safe during labour (U) (Level I).
2. Nitrous oxide is an effective analgesic agent in a variety of other acute pain situations (U)
(Level II).
3. Methoxyflurane, in low concentrations, may be an effective analgesia in the hospital and
prehospital setting (N) (Level IV).
 Neuropathy and bone marrow suppression are rare but potentially serious complications
of nitrous oxide use, particularly in at‐risk patients (U).

Acute pain management: scientific evidence xxiii