title: A meta-analysis of the use of nonsteroidal antiinflammatory drugs for pediatric postoperative pain.
abstract: BACKGROUND
  Opioid side effects are a great concern during the postoperative period in children. Nonsteroidal antiinflammatory drugs (NSAIDs) have been shown to effectively decrease postoperative pain, but their opioid-sparing effect is still controversial. In this present meta-analysis, we investigated the postoperative opioid-sparing effect of NSAIDs in children.
  
  
  METHODS
  A comprehensive literature search was conducted to identify clinical trials using NSAIDs and opioids as perioperative analgesic compounds in children and infants. Outcomes measured were opioid consumption, pain intensity, postoperative nausea and vomiting (PONV), and urinary retention. All outcomes were studied during postanesthesia care unit (PACU) stay and the first 24 postoperative hours. Data from each trial were combined to calculate the pooled odds ratios (ORs) or standardized mean difference (SMD) and their 95% confidence interval.
  
  
  RESULTS
  Twenty-seven randomized controlled studies were analyzed. Perioperative administration of NSAIDs decreased postoperative opioid requirement (both in the PACU and during the first 24 postoperative hours; SMD = -0.66 [-0.84, -0.48] and -0.83 [-1.11, -0.55], respectively), pain intensity in the PACU (SMD = -0.85 [-1.24, -0.47]), and PONV during the first 24 postoperative hours (OR = 0.75 [0.57-0.99]). NSAIDs did not decrease pain intensity during the first 24 postoperative hours (OR = 0.56 [0.26-1.2]) and PONV during PACU stay (OR = 1.02 [0.73-1.44]). Subgroup analysis according to the timing of NSAID administration (intraoperative versus postoperative), type of surgery, or coadministration of paracetamol did not show any influence of these factors on the studied outcomes except the reduction of pain intensity and the incidence of PONV during the first 24 postoperative hours, which were influenced by the coadministration of paracetamol and the type of surgery, respectively.
  
  
  CONCLUSIONS
  This meta-analysis shows that perioperative NSAID administration reduces opioid consumption and PONV during the postoperative period in children.
authors: Department of Anesthesia, Intensive Care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris, France.
authors: Daphne
authors: D
authors: Michelet
authors: Juliette
authors: J
authors: Andreu-Gallien
authors: Tarik
authors: T
authors: Bensalah
authors: Julie
authors: J
authors: Hilly
authors: Chantal
authors: C
authors: Wood
authors: Yves
authors: Y
authors: Nivoche
authors: Jean
authors: J
authors: Mantz
authors: Souhayl
authors: S
authors: Dahmani
mesh_terms: D000293:Adolescent; D000367:Age Factors; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D016017:Odds Ratio; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal