Intended for healthcare professionals

News

Safety and efficacy of routine postoperative ibuprofen for pain and disability related to ectopic bone formation after hip replacement surgery (HIPAID): randomised controlled trial

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38925.471146.4F (Published 07 September 2006) Cite this as: BMJ 2006;333:519

NSAIDs are very useful after hip replacement surgery

EDITOR - Fransen et al conclude that ibuprofen should not be used as
routine prophylaxis for preventing ectopic bone formation in patients
undergoing total hip replacement and stress the failure to decrease
chronic pain and discomfort following the use of this drug. [1]
While we understand the recommendation not to give non-steroidal anti-
inflammatory drugs (NSAIDs) routinely (drugs with such a well known list
of adverse effects should always be prescribed on a patient by patient
basis) we are concerned that misinterpretation of this study may
predispose some clinicians to withhold these drugs early on in the peri-
operative phase. NSAIDs are recognised to be useful adjuncts in those who
have undergone recent surgery.[2.3.] Not only do they provide profound
analgesia but they also decrease opiate usage in those without continuous
intrathecal or epidural analgesia and with appropriate patient choice and
prescription they have an acceptable side effect profile. Regular opiate
prescription in the post-operative period may lead to respiratory
depression can have other serious consequences, especially for the elderly
such as constipation.
The final paragraph of Drs Birrell and Lohmander’s excellent Editorial
stating that “on balance, this study shows that NSAIDs should not be given
routinely after hip replacement surgery” [4] may be taken out of context.
This conclusion could result in many elderly patients experiencing either
unnecessary post operative pain or unfortunate side effects of opioid
analgesia.

Oliver Seyfried SHO Anaesthesia

David Wilkinson, Consultant Anaesthetist
Homerton University Foundation NHS Trust, Homerton Row, London E9 6SR
davidwilkinson1@compuserve.com

Competing interests: None declared

References:

1. Fransen M., Anderson C., Douglas J., Macmahon S., Neal B., Norton
R., Woodward M., Cameron ID., Crawford R., Lo SK., Tregonning G., Windolf
M. Safety and efficacy of routine postoperative ibuprofen for pain and
disability related to ectopic bone formation after hip replacement surgery
(HIPAID): randomised controlled trial. British Medical Journal 2006; 333:
519-521.

2. Cashman JN., Dolin SJ. Respiratory and haemodynamic effects of
acute postoperative pain management: evidence from published data. British
Journal of Anaesthesia 2004; 93: 212-223.

3. Burns JW, Aitken HA, Bullingham RE, et al. Double-blind comparison
of the morphine sparing effect of continuous and intermittent im
administration of ketorolac. British Journal of Anaesthesia 1991;67:235-
238.

4. Birell F, Lohmander S. Non-steroidal anti-inflammatory drugs after
hip replacement. British Medical Journal 2006; 333: 507-508.

Competing interests:
None declared

Competing interests: No competing interests

20 September 2006
David J Wilkinson
Consultant anaesthetist
Oliver Seyfried
Homerton hospital, London E9 6SR.