Non-Steroidal anti inflammatory drugs usage in orthopaedics and trauma practice. A guide and review

Non steroidal anti-inflammatory drugs (NSAIDs) are a group of heterogeneous compounds with anti inflammatory, analgesic and often times anti pyretic properties. They are weak organic acids and are the most commonly used drugs in Orthopaedic/Trauma practice. They provide mild to moderate pain relief. NSAID share common therapeutic and side effects irrespective of the class or group to which an individual drug may belong. These side effects are many and varied and constitute a major concern in their usage since most of them are life threatening. The NSAIDs are also one of the most commonly abused drugs. The abuses stem mostly from poor prescription habit by the health professionals. The poor prescription habit by the professionals and laissez-a-faire attitude to NSAID Usage informed the need for this review which addresses the issues, controversies and preventive strategies to reduce the complications in Orthopedics/Trauma practice.

Literature on the subject was reviewed extensively using manual library internet search. Publications from local and international Journals spanning a period of over thirty years were reviewed. The internet search was done using pubmed and ortholink search engines.

NSAIDs act locally at the site of origin of pain by inhibiting the cyclooxygenase enzymes and induce no change in mood and dependency The inhibition of the Cox enzymes can be reversible or irreversible and leads to inhibition of prostaglandin synthesis. All the therapeutic and most of the side effects of NSAIDs result from the inhibition of the cyclooxygenase pathway. Thus the Cox-2 selective inhibitors have lesser side effects than the non selective Cox inhibitors; though there is recent evidence linking them with adverse cardiovascular events. There is paucity of information in literature on the guidelines of the prescription/usage of NSAIDs, and the preventive strategies in orthopedics and traumatology.

NSAIDs are the most commonly prescribed group of drugs in orthopedics and trauma practice. They constitute a great asset to any Doctor who deals with pains associated with inflammation which they relief quite effectively. NSAID Usage is froth with significant life threatening complications. A high index of suspicion of the possibility of occurrence of these complications, adherence to proper prescription guidelines and preventive strategies, change of the laissez-a-faire attitude of the professionals to NSAID prescription and appropriate monitoring of the patients on the drugs are paramount in improving their safety profiles. Orthopedic and Trauma surgeons need to be aware of the serious side effects and the role of preventive strategies in the use of NSAIDs.