Inhibition of the enzyme cyclooxgenase preventing synthesis of prostaglandin and thromboxane.
Mild to moderate pain, inflammation, and fever.
Adverse Effects and Contraindications
|Cardiovascular||Hypertension, can exacerbate or induce heart failure, thrombotic events, possible increased risk of thrombotic/cardiovascular events with long-term use (use with caution in patients with preexisting disease; more likely with Cox2 inhibitors)|
|Respiratory||Nasal polyps, rhinitis, dyspnea, bronchospasm, angioedema, may exacerbate asthma|
|Gastrointestinal||Gastropathy (can be asymptomatic), gastric bleeding, esophageal disease, pancreatitis|
|Hematological||Increased intraoperative bleeding due to platelet inhibition/dysfunction (coxibs do not affect platelet function), will potentiate anticoagulation effect|
|Dermatological||Urticaria, erythema multiforme, rash|
|Genitourinal||Renal insufficiency (use with caution in patients with preexisting renal disease), sodium/fluid retention, papillary necrosis, interstitial nephritis|
|Central nervous system||Headache, aseptic meningitis, hearing disturbances|
|Skeletal||Potential to inhibit bone growth/healing/formation|
|Pharmacologic interactions||NSAIDs displace albumin-bound drugs and can potentiate their effects (e.g., warfarin)|
ASRA consensus guidelines: nonsteroidal anti-inflammatory drugs (NSAIDs) alone should not interfere with the performance of neuraxial blocks or the timing of neuraxial catheter removal.
At many institutions, it is customary for the anesthesiology team to verbally confirm adequate hemostasis (and surgeon’s agreement) prior to administering IV NSAIDs.
Nonselective COX-1 and COX-2 inhibitors and selective COX-2 inhibitors:
|Salicylate||Salsate, diflunisal, and choline magnesium trisalicylate|
|Proprionic||Ibuprofen, ketoprofen, naproxen, fenoprofen|
|Indole||Indomethacin, sulindac, tolmetin|
|Mixed||Piroxicam, ketorolac, diclofenac|
|Coxib (only selective COX-2 inhibitor)||Celecoxib (rofecoxib/valdecoxib removed from market)|
|Drug (PO—adult usage)||Starting dose||Maximum dose|
|Aspirin (Bayer)||325 mg q6 h||975 mg q6 h|
|Celecoxib (Celebrex)||100 mg q12 h||200 mg q12 h|
|Diclofenac potassium (Cataflam)||50 mg q12 h||50 mg q8 h|
|Diclofenac sodium (Voltaren)||50 mg q12 h||50 mg q8 h|
|Etodolac (Lodine)||200 mg q8 h||400 q8 h|
|Fenoprofen calcium (Nalfon)||200 mg q6 h||800 mg q6 h|
|Flurbiprofen (Ansaid)||50 mg q8 h||100 mg q8 h|
|Ibuprofen (Advil, Motrin)||200 mg q6 h||800 mg q6 h|
|Indomethacin (Indocin)||25 mg q12 h||50 mg q8 h|
|Ketoprofen (Orudis, Oruvail)||25 mg q8 h||75 mg q6 h|
|Meloxicam (Mobic)||7.5 mg q day||15 mg q day|
|Nabumetone (Relafen)||1,000 mg q day||2,000 mg q day|
|Naproxen (Naprosyn, Naprelan)||250 mg q8 h||500 mg q8 h|
|Naproxen sodium (Aleve, Anaprox)||275 mg q8 h||550 mg q8 h|
|Oxaprozin (Daypro)||600 mg q day||1,200 mg q day|
|Piroxicam (Feldene)||10 mg q day||20 mg q day|
|Salsalate (Amigesic, Anaflex)||1,000 mg q8 h||1,000 mg q8 h|
|Sulindac (Clinoril)||150 mg q12 h||200 mg q12 h|
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