///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Analgesic Efficacy of Nonsteroidal Anti-inflammatory Agents after Cesarean Section

Abstract Number: 162
Abstract Type: Meta Analysis/Review of the Literature

Gillian Newman MD, PhD1 ; Jamie Murphy MD2; Christina Khalil BS3; Kerry Blaha MD4; Cristianna Vallera MD5; Christopher Wu MD6

Background: Postoperative pain after Cesarean section can be difficult to manage. Adjuvant agents such as nonsteroidal anti-inflammatory agents (NSAIDs) may be an important part of a multimodal approach to postoperative pain management. We examined the analgesic efficacy of NSAIDs for postoperative pain management after Cesarean section.

Methods: This project is exempt from the Johns Hopkins IRB. We used the National Library of Medicines Medline database to search for terms related to nonsteroidal anti-inflammatory agents (NSAIDs) and Cesarean section. Inclusion criteria were randomized controlled trials (RCTs) comparing NSAIDs to placebo for postoperative pain after Cesarean section and RCTs published in the English language. Relevant data were abstracted from accepted studies. Meta-analysis was performed using RevMan 4.2.10 (Cochrane Collaboration, 2004). A random effects model was used.

Results: A total of 718 abstracts were obtained from the above search and a total of 16 RCTs met the above inclusion criteria. Use of NSAIDs versus placebo was associated with significantly lower pain scores at 12 (weighted mean difference [WMD] = -1.09, 95% confidence interval [CI] = -1.65 to -0.53) and 24 (WMD = -1.00, 95% CI = -1.71 to -0.29) hours after surgery. However, use of NSAIDs versus placebo was not associated with a lower odds of opioid-related side effects such as postoperative nausea and vomiting (Odds ratio [OR] = 1.40, 95% CI = 0.95-2.05), pruritus (OR = 0.95, 95% CI = 0.49-1.82), or sedation/dizziness (OR = 0.68, 95% CI = 0.30-1.56).

Discussion: Compared to placebo, the use of NSAIDs provides statistically lower pain scores after Cesarean section. However, the use of NSAIDs was not associated with lower odds of opioid-related side effects such as postoperative nausea and vomiting, pruritus, or sedation. Due to the relatively small sample size, no determination of the relative "safety" (e.g., respiratory depression) of one regimen over the other can be made and larger RCTs would be needed for such a determination.

SOAP 2009