Local infiltration with NSAIDs for postoperative analgesia: evidence for aperipheral analgesic action

Background: In order to investigate the evidence for a peripheral analgesic effect of local infiltration with nonsteroidal antiinflammatory drugs (NSA IDs) in postoperative pain, we conducted a systematic review. Methods: Randomised controlled and double-blind trials were evaluated. Outc ome measures were pain scores, the use of supplementary analgesics, and tim e to first analgesic request. Efficacy was estimated by significant differe nce (P<0.05) as reported in the original reports and by calculation of the weighted mean difference of pain scores between treatment groups. Results: Sixteen studies with data from 844 patients were considered approp riate for analysis. The NSAIDs were administered as intra-articular injecti ons, as components of intravenous regional anaesthesia (IVRA), and by wound infiltration and were compared with systemic administration or placebo. In the four studies comparing intra-articular NSAIDs with systemic administra tion a statistically significant effect in favour of intraarticular NSAIDs was found. Only one study compared IVRA NSAID with systemic administration, showing a significant effect in favour of IVRA administration. No more tha n two of the five studies comparing intrawound NSAIDs with systemic adminis tration showed significant effect after intrawound administration. Most of the studies comparing local infiltration with placebo showed significant ef fect in favour of local infiltration. Conclusion: There is evidence for a clinically relevant peripheral analgesi c action of intra-articular NSAIDs while results of IVRA and wound infiltra tion with NSAIDs in postoperative pain are inconclusive. Trials without a s ystemic control group were not considered to provide evidence for a local e ffect. (C) Acta Anaesthesiologica Scandinavica 44 (2000).