Colonic anastomoses and non-steroidal anti-inflammatory drugs - 30/08/16
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Groupe Francophone de Réhabilitation Améliorée après Chirurgie (GRACE)d
Summary |
Nonsteroidal anti-inflammatory drugs (NSAID) play an important role in the treatment of post-operative pain, particularly in the context of enhanced recovery after colorectal surgery. Several recent articles have suggested that NSAID may have a deleterious effect on colo-colic or colo-rectal anastomoses. The aim of this review is to analyze the evidence based on meta-analyses and cohort studies in the literature. A systematic review of clinical studies identified twelve studies including two meta-analyses and ten comparative cohort studies that included a large number of patients. The data in these studies are heterogeneous, often biased, and do not permit a formal recommendation based on a high level of evidence. The main conclusion of this review is that the balance of benefit vs. risk (analgesic effect/risk of anastomotic disruption) is acceptable; it appears (with a low level of evidence) that a prescription of NSAID for 48h after surgery may be recommended for elective colon surgery. Nevertheless, it is important to respect the specific contra-indications of NSAID and avoid post-operative NSAID use if there are risk factors for anastomotic leakage: advanced age, malnutrition, severe co-morbidities, intra-operative difficulties.
El texto completo de este artículo está disponible en PDF.Keywords : Colonic anastomosis, Anastomotic leak, NSAID, Enhanced recovery
Esquema
Vol 153 - N° 4
P. 269-275 - août 2016 Regresar al númeroBienvenido a EM-consulte, la referencia de los profesionales de la salud.