Postoperative Pain Outcomes Superior With Nonopioids vs Opioids

Outpatients reported better postoperative pain outcomes after receiving nonsteroidal anti-inflammatory drugs (NSAIDs) vs analgesics containing the opioid codeine, according to findings published in the Canadian Medical Association Journal.

“Postoperative pain management after outpatient procedures often includes low-potency or low-dose opioids,” authors wrote. “Amid the ongoing opioid crisis, management of pain and potential opioid misuse is important across all medical and dental specialties.”

The systematic review and meta-analysis included randomized controlled trials comparing NSAIDs to codeine from the MEDLINE and Embase databases up to October 2019. Researchers evaluated patient pain scores, patient-reported global assessments, and adverse effects.

Forty studies met inclusion criteria, encompassing 102 trial arms and 5116 patients.

Authors noted better pain scores at 6 hours (weighted mean difference [WMD] .93 points, 95% CI.71 to 1.15) and 12 hours (WMD .79, 95% CI .38 to 1.19) in patients who received NSAIDs as opposed to codeine.

NSAIDs showed greater superiority over codeine at 6 hours when “acetaminophen was coadministered at equivalent doses between groups (WMD 1.18, 95% CI .87 to 1.48).” Researchers also reported better global assessments among patients receiving NSAIDs at 6-hour (WMD -.88, 95% CI -1.04 to -.72) and 24-hour intervals (WMD -.67, 95% CI -.95 to -.40).

Compared to codeine, NSAIDs were also linked to fewer adverse effects, which can include gastrointestinal bleeding, renal impairment, and myocardial infarction.

“These findings strengthen existing evidence and are broadly generalizable to patients across surgical disciplines,” study authors concluded. “Clinicians across all specialties can use this information to improve both pain management and opioid stewardship.”

Reference:
Choi M, Wang L, Coroneos CJ, Voineskos SH, Paul J. Managing postoperative pain in adult outpatients: a systematic review and meta-analysis comparing codeine with NSAIDs. CMAJ. 2021;193(24):E895-E905. doi:10.1503/cmaj.201915