Abstract

Cesarean section is associated with moderate to severe pain and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly employed. The optimal NSAID, however, has not been elucidated. In this network meta-analysis and systematic review, we compared the influence of control and individual NSAIDs on indices of analgesia, side effects and quality of recovery.CDSR, CINAHL, CRCT, Embase, LILACS, PubMed and Web of Science were searched for randomized controlled trials which compared a specific NSAID to either control or another NSAID in the context of elective or emergency cesarean section under general or neuraxial anesthesia. Network plots and league tables were constructed, and the quality of evidence was evaluated with GRADE analysis.In all, we included 47 trials. Cumulative intravenous morphine equivalent consumption at 24 h, the primary outcome, was examined in 1228 patients and 18 trials, and control was found to be inferior to diclofenac, indomethacin, ketorolac and tenoxicam (very low quality of evidence owing to serious limitations, imprecision and publication bias). Indomethacin was superior to celecoxib for the pain score at rest at 8-12 h and celecoxib + parecoxib, diclofenac and ketorolac for the pain score on movement at 48 h. In regard to the need for and time to rescue analgesia, cyclooxygenase two inhibitors such as celecoxib were inferior to other NSAIDs.Our review suggests the presence of minimal differences among the NSAIDs studied. Nonselective NSAIDs may be more effective than selective NSAIDs, and some NSAIDs such as indomethacin might be preferable to other NSAIDs.

View details for DOI 10.4097/kja.23014

View details for PubMedID 37066603