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Potential Renal, Haematological and Allergic Adverse Effects Associated with Nonsteroidal Anti-Inflammatory Drugs

Drugs volume 44, pages 31–37 (1992)Cite this article

Summary

The major benefits of the perioperative administration of nonsteroidal anti-inflammatory drugs (NSAIDs) are related to the ability of these agents to provide analgesia without cardiovascular or respiratory depression. However, there are several possible adverse effects of NSAIDs.

All NSAIDs reduce the synthesis of prostaglandins by the kidneys, but their administration in the perioperative period appears to have little potential for renal toxicity when adequate hy-dration is maintained and renal function is not dependent on renal prostaglandins. However, NSAIDs may cause impairment of renal function in patients with conditions such as hypovol-aemia, congestive cardiac failure, or hepatic cirrhosis, since renal function in these patients may be dependent on the vascular effects of prostaglandins.

Platelet aggregation is inhibited by the administration of NSAIDs, and most studies of their haematological effects report that NSAIDs are associated with an increase in bleeding times. In patients with normal haemostatic function before NSAID administration, almost all indices of coagulation remain within the normal range after.NSAID treatment. Most studies of perioperative blood loss have reported no significant difference between the effects of NSAIDs and placebo in this regard.

The incidence of major allergic reactions in the general population appears to be small with NSAIDs.

Overall, NSAIDs appear to be safe and well tolerated drugs with a valuable role to play in the treatment of postoperative pain.

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References

  • Aitken HA, Burns JW, McArdle CS, Kenny GNC. Effects of ke-torolac trometamol on renal function. British Journal of Anaesthesia 68: 481–485, 1992

    PubMed  Article  CAS  Google Scholar 

  • Bosso JV, Creighton D, Stevenson DD. Flurbiprofen cross-sensitivity in an aspirin-sensitive patient. Chest 101: 856–858, 1992

    PubMed  Article  CAS  Google Scholar 

  • Brandon Bravo LJC, Mattie H, Spierdijk J, Bovill JG, Burm AGL. The effects on ventilation of ketorolac in comparison with morphine. European Journal of Clinical Pharmacology 35: 491–494, 1988

    Article  CAS  Google Scholar 

  • Bricker SRW, Savage ME, Hanning CD. Peri-operative blood loss and non-steroidal anti-inflammatory drugs: an investigation using diclofenac in patients undergoing transurethral resection of the prostate. European Journal of Anaesthesiology 4: 429–434, 1987

    PubMed  CAS  Google Scholar 

  • Burns J, Aitken H, Kenny GNC, McArdle CS. The morphine sparing effect of continuous and intermittent ketorolac. British Journal of Anaesthesia 67: 235–238, 1991

    PubMed  Article  CAS  Google Scholar 

  • Catling JA, Pinto DM, Jordan C, Jones JG. Respiratory effects of analgesia after cholecystectomy: comparison of continuous and intermittent papaveretum. British Medical Journal 281: 478–480, 1980

    PubMed  Article  CAS  Google Scholar 

  • Clive DM, Stoff JS. Renal syndromes associated with non-steroidal antiinflammatory drugs. New England Journal of Medicine 310: 563–572, 1984

    PubMed  Article  CAS  Google Scholar 

  • Conrad KA, Fagan TC, Mackie MJ, Mayshar PV. Effects of ketorolac tromethamine on haemostasis in volunteers. Clinical Pharmacology and Therapeutics 43: 542–546, 1988

    PubMed  Article  CAS  Google Scholar 

  • Cronberg S, Wallmark E, Soderberg I. Effects on platelet aggregation of oral administration of 10 non-steroidal analgesics to humans. Scandinavian Journal of Haematology 33: 155–159, 1984

    PubMed  Article  CAS  Google Scholar 

  • Dibona GF. Prostaglandins and nonsteroidal anti-inflammatory drugs. American Journal of Medicine 80(Suppl. 1A): 12–21, 1986

    PubMed  Article  CAS  Google Scholar 

  • Dunn MJ. Nonsteroidal antiinflammatory drugs and renal function. Annual Review of Medicine 35: 411–428, 1984

    PubMed  Article  CAS  Google Scholar 

  • Engel C, Lund B, Kristensen SS, Axel C, Nielsen JB. Indomethacin as an analgesic after hysterectomy. Acta Anaesthesiologica Scandinavica 33: 498–501, 1989

    PubMed  Article  CAS  Google Scholar 

  • Gillies GWA, Kenny GNC, Bullingham RES, McArdle CS. The morphine sparing effects of ketorolac tromethamine. A study of a new, parenteral non-steroidal anti-inflammatory agent after abdominal surgery. Anaesthesia 42: 727–731, 1987

    PubMed  Article  CAS  Google Scholar 

  • Hodsman NBA, Burns JW, Blyth A, Kenny GNC, McArdle CS, et al. The morphine sparing effect of diclofenac sodium following upper abdominal surgery. Anaesthesia 42: 1005–1008, 1987

    PubMed  Article  CAS  Google Scholar 

  • Kehlet H, Dahl JB. Are perioperative prostaglandin synthetase inhibitors ulcerogenic in the short term? Drugs 44(Suppl. 4): 38–41, 1992

    PubMed  Article  Google Scholar 

  • Ko***Ch-Weser J. Nonsteroidal antiinflammatory drugs. New England Journal of Medicine 302: 1179–1185, 1980

    Article  Google Scholar 

  • Lindgren U, Djupso H. Diclofenac for pain after hip surgery. Acta Anaesthesiologica Scandinavica 56: 28–31, 1985

    CAS  Google Scholar 

  • Moffat AC, Kenny GNC, Prentice JW. Postoperative nefopam and diclofenac. Evaluation of their morphine sparing effect after upper abdominal surgery. Anaesthesia 45: 302–305, 1990

    PubMed  Article  CAS  Google Scholar 

  • Murray MD, Brater DC. Adverse effects of non-steroidal drugs on renal function. Annals of Internal Medicine 112: 559–560, 1990

    PubMed  CAS  Google Scholar 

  • Murray AW, Brockway MS, Kenny GNC. Comparison of the car-diorespiratory effects of ketorolac and alfentanil during pro-pofol anaesthesia. British Journal of Anaesthesia 63: 601–603, 1989

    PubMed  Article  CAS  Google Scholar 

  • Nizankowska E, Czerniawska-Mysik G, Szczeklik A. The effect of prostacyclin on asthma precipitated by aspirin. Allergy and Immunology 19: 22–24, 1987

    PubMed  CAS  Google Scholar 

  • Orme ML. Leading Article: Non-steroidal anti-inflammatory drugs and the kidney. British Medical Journal 292: 1621–1622, 1986

    PubMed  Article  CAS  Google Scholar 

  • Passmore AP, Copeland S, Johnston GD. The effects of ibuprofen and indomethacin on renal function in the presence and absence of frusemide in healthy volunteers on a restricted sodium diet. British Journal of Clinical Pharmacology 29: 311–319, 1990

    PubMed  Article  CAS  Google Scholar 

  • Perttunen K, Kalso E, Heinonen J, Salo J. I.V. diclofenac in post-thoracotomy pain. British Journal of Anaesthesia 68: 474–480, 1992

    PubMed  Article  CAS  Google Scholar 

  • Power I, Noble DW, Douglas E, Spence AA. Comparison of i.m. ketorolac tromethamol and morphine sulphate for pain relief after cholecystectomy. British Journal of Anaesthesia 65: 448–455, 1990

    PubMed  Article  CAS  Google Scholar 

  • Reasbeck PG, Rice MI, Reasbeck JC. Double-blind controlled trial of indomethacin as an adjunct to narcotic analgesia after major abdominal surgery. Lancet 2: 115–118, 1982

    PubMed  Article  CAS  Google Scholar 

  • Rorarius MGF, Baer GA, Metsa-Ketela T, Miralies J, Palomaki E, et al. Effects of peri-operatively administered diclofenac and indomethacin on blood loss, bleeding time and plasma pros-tanoids in man. European Journal of Anaesthesiology 6: 335–342, 1989

    PubMed  CAS  Google Scholar 

  • Rosen M. Leading Article: Patient controlled analgesia. British Medical Journal 289: 640–641, 1984

    PubMed  Article  CAS  Google Scholar 

  • Runciman WB, Mather LE. The effects of anaesthesia on drug disposition. In Felman SA et al. (Eds) Drugs in anaesthesia. Mechanisms of action, pp. 87–122, Edward Arnold, London, 1987

    Google Scholar 

  • Spowart K, Greer IA, McLaren M, Lloyd J, Bullingham RES, et al. Haemostatic effects of ketorolac with and without concomitant administration of heparin in normal volunteers. Thrombosis and Haemostasis 60: 382–386, 1988

    PubMed  CAS  Google Scholar 

  • Szczeklik A. Adverse reactions to aspirin and nonsteroidal antiinflammatory drugs. Annals of Allergy 59: 113–118, 1987

    PubMed  CAS  Google Scholar 

  • Taivainen T, Hiller A, Rosenberg PH, Neuvonen O. The effect of continuous intravenous indomethacin infusion on bleeding time and postoperative pain in patients undergoing emergency surgery of the lower extremities. Acta Anaesthesiologica Scandinavica 33: 58–60, 1989

    PubMed  Article  CAS  Google Scholar 

  • Toon S, Holt BL, Mullins FG, Bullingham R, Aarons L, et al. Investigations into the potential effects of multiple dose ketorolac on the pharmacokinetics and pharmacodynamics of ra-cemic warfarin. British Journal of Clinical Pharmacology 30: 743–750, 1990

    PubMed  Article  CAS  Google Scholar 

  • Weiss HJ, Aledort LM, Kochwa S. The effect of salicylates on the haemostatic properties of platelets in man. Journal of Clinical Investigation 47: 2169–2180, 1968

    PubMed  Article  CAS  Google Scholar 

  • Whelton A, Stout RL, Spilman PS, Klassen DK. Renal effects of ibuprofen, piroxicam and sulindac in patients with asymptomatic renal failure. Annals of Internal Medicine 112: 568–576, 1990

    PubMed  CAS  Google Scholar 

  • Yee JP, Koshiver JE, Allbon C, Brown CR. Comparison of intramuscular ketorolac tromethamine and morphine sulfate for analgesia after major surgery. Pharmacotherapy 6: 253–261, 1986

    PubMed  CAS  Google Scholar 

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  1. Royal Infirmary, University Department of Anaesthesia, 8-16 Alexandra Parade, Glasgow, G31 2ER, Scotland

    Gavin N. C. Kenny

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  1. Gavin N. C. Kenny
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Kenny, G.N.C. Potential Renal, Haematological and Allergic Adverse Effects Associated with Nonsteroidal Anti-Inflammatory Drugs. Drugs 44, 31–37 (1992). https://doi.org/10.2165/00003495-199200445-00005

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  • DOI: https://doi.org/10.2165/00003495-199200445-00005

Keywords

  • Morphine
  • Renal Blood Flow
  • Ketorolac
  • Bleeding Time
  • Congestive Cardiac Failure