塞来昔布在骨科围手术期镇痛应用.pptVIP

* Nonselective NSAIDs inhibit both COX-1 and COX-2. By inhibiting COX-1, however, NSAIDs can reduce platelet aggregation and increase bleeding risk. NSAIDs demonstrate a ceiling effect in pain relief; further dose escalation increases adverse effects.1,2 While nonselective NSAIDs are considered efficacious in managing pain, physicians may be reluctant to use them due to their risks of CV, skin, GI, and antiplatelet effects3-5 Some of the GI side effects of NSAIDs can be mitigated by adding a proton pump inhibitor to a patient’s drug regimen. However, concomitant treatment with a gastroprotective agent incurs greater expense and adds to the complexity of treatment6 NSAIDs may mask fever. After surgery, the site of incision should be carefully observed to detect signs of infection References: 1. Power I, Barratt S. Analgesic agents for the postoperative period. Nonopioids. Surg Clin North Am. 1999;79:275-295. 2. Atcheson R, Rowbotham DJ. Pharmacology of acute and chronic pain. In: Rawal N, ed. Management of Acute and Chronic Pain. London, England: BMJ Books; 1998:23-50. 3. Brooks P. Use and benefits of nonsteroidal anti-inflammatory drugs. Am J Med. 1998;104(suppl 3a):9S-13S. 4. FDA Public Health Advisory: FDA announces important changes and additional warnings for COX-2 selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs). April 7, 2005. Available at: /cder/drug/advisory/COX2.htm. Accessed September 13, 2005. 5. FDA proposed NSAID package label insert labeling template. Available at: /cder/drug/infopage/cox2/NSAIDRxTemplate.pdf. Accessed September 12, 2005. 6. Hunt RH, Barkun AN, Baron D, et al. Recommendations for the appropriate use of anti-inflammatory drugs in the era of the coxibs: defining the role of gastroprotective agents. Can J Gastroenterol. 2002;16:231-240. * Nonselective NSAIDs can significantly increase bleeding time vs placebo as a result of their action on platelets.1 Because of their COX-1 inhibition, nonselective NSAIDs s