PERIOPERATIVE USE OF NONSTEROIDAL ANTIINF LAMMATORY DRUGS - CLINICAL RELEVANCE AND LIMITS

Nonsteroidal antiinflammatory drugs (NSAIDs), including various chemic al families of drugs, inhibit prostaglandin synthesis and act on the c entral nervous system. Prostaglandins are involved in regulation of re gional circulations, cell turn-over in the gastrointestinal tract, and in primary haemostasis. The patterns of action of NSAIDs result in an algesic properties, but also in adverse effects. NSAIDs are increasing ly used perioperatively, alone or associated with opioids or local ana esthetics, because of their analgesic and opioid sparing properties. S ome of their adverse effects, especially ischaemic acute renal failure and gastrointestinal complications, can be life-threatening, and incr eased haemorrhagic risk is an issue for spinal or epidural anaesthesia in patients taking aspirin. Safe use of NSAIDs is possible in conside ration of contraindications (elderly patient, hypovolaemia, cirrhosis, congestive heart failure, renal failure, active gastrointestinal ulce r, bleeding diathesis, pregnancy), and requires close monitoring of re nal function if they must be used in patients at risk for renal failur e. NSAIDs are not ulcerogenic in the short-term in healthy subjects. T hey must be used with caution in patients with a preexisting haemostat ic defect or undergoing haemorrhagic surgical procedures.