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The impact of perioperative nonsteroidal anti-inflammatory drugs on the postoperative outcomes of spinal surgery: a meta-analysis of 23 randomized controlled trials

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Abstract

In recent years, nonsteroidal anti-inflammatory drug (NSAIDs), which are considered to affect the prognosis of spinal surgery, have been widely used in perioperative analgesia in spinal surgery, but the relationship between these two factors remains unclear. The purpose of this study was to explore the effect of perioperative use of NSAIDs on the prognosis of patients treated with spinal surgery. We systematically searched PubMed, Embase, and Cochrane Library for relevant articles published on or before July 14, 2023. We used a random-effect model for the meta-analysis to calculate the standardized mean difference (SMD) with a 95% confidence interval (CI). Sensitivity analyses were conducted to analyze stability. A total of 23 randomized clinical trials including 1457 participants met the inclusion criteria. Meta-analysis showed that NSAIDs were significantly associated with postoperative morphine use (mg) (SMD = -0.90, 95% CI -1.12 to -0.68) and postoperative pain (SMD = -0.71, 95% CI -0.85 to -0.58). These results were further confirmed by the trim-and-fill procedure and leave-one-out sensitivity analyses. The current study shows that perioperative use of NSAIDs appears to be an important factor in reducing postoperative pain and morphine use in patients undergoing spinal surgery. However, well-designed, high-quality randomized controlled trials (RCTs) are still required.

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Data availability

All the data sets used and analysed in this study were published and are available and can be shared by eligible investigators.

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Funding

This work was supported by the Health and Family Planning Commission Program of Hunan Province (no. 202204074707), and the Health and Family Planning Commission Program of Wuhan City (no. WX18C29).

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Authors and Affiliations

  1. Department of spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, 421000, China

    Mingjiang Luo & Zhihong **ao

  2. Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China

    Gaigai Yang, Huijie Dai, Fuwen Shi, Zhifeng Tang, Jijun Tan, Yang Kang, **g Jiang, Jie **e, Zhiyuan Yi, Beijun Zhou, Zuoxuan Chen, Hongxu Wang & Deyao Kong

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  1. Mingjiang Luo
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Contributions

ML and GY conceived the idea for the review and with all other authors designed the protocol. FS, ZT, JT, YK, BZ, ZC, DK, JJ, JX, ZY and HW constructed the search. ML, GY and HD selected the studies and extracted the relevant data. ML and ZX wrote the original draft and ZX, ML and ZX critically revised and edited successive drafts of the paper. All authors gave final approval of the version to be submitted.

Corresponding author

Correspondence to Zhihong **ao.

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Luo, M., Yang, G., Dai, H. et al. The impact of perioperative nonsteroidal anti-inflammatory drugs on the postoperative outcomes of spinal surgery: a meta-analysis of 23 randomized controlled trials. Neurosurg Rev 47, 140 (2024). https://doi.org/10.1007/s10143-024-02371-7

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