Optimal management requires correct dose by the correct route and at the correct time
We read with great interest the article by Fransen and colleagues
(1). There are few points we would like to highlight:
Firstly, the efficacy dose-response curve for NSAIDs is flat compared with
the dose-response for adverse effects such as gastrointestinal symptoms,
dizziness, and drowsiness (3). Increasing the dose to improve analgesia is
therefore more likely to increase adverse effects than to improve
Optimal management requires that the correct drugs are available, and that
they are given in the correct dose by the correct route and at the correct
time. British National Formulary (BNF) recommends: initially 1.2-1.8g
daily in 3-4 divided doses; increased if necessary to max. 2.4g
daily;maintenance dose 0.6-1.2 g daily may be adequate. It is still
controversial whether the increased harm caused by COX-2 selective NSAIDs
a dose-related phenomenon or not?
Secondly, non steroidal anti-inflammatory drugs (NSAIDs) are known to
reversibly affect platelet function (2). The safety of regional
anaesthesia in these group of patients remains a crucial issue amongst
anaesthetists (62%, 8% had spinal and epidural respectively).
Thirdly, we think that the availability of ibuprofen preparation to
the public, duration of stay, number of outpatient appointments and post-
operative physiotherapy sessions; all might be very important variables.
1. Fransen M et al. 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;
2. Celecoxib, ibuprofen, and the antiplatelet effect of aspirin in
patients with osteoarthritis and ischemic heart disease. Clin Pharmacol
Ther 2006; 80 (3):264-274.
3. Eisenberg E et al. Efficacy and safety of nonsteroidal
antiinflammatory drugs for cancer pain: a meta-analysis. J Clin Oncol
1994; 12 , 2756-2765.
Dr. Hamzeh Hussein-SHO Anaesthetics
Dr. Andrew Toner- SHO Anaesthetics
Anaesthetic and Critical Care Department
Royal Surrey county Hospital
Guildford, GU2 7XX
Competing interests: No competing interests