Combinatie NSAID paracetamol postop pijn

Laatst beoordeeld: 01-07-2013

Uitgangsvraag

Combinatie NSAID met paracetamol

Aanbeveling

Er zijn voor deze submodule geen aanbevelingen opgesteld.

Overwegingen

Op basis van methodologie van de individuele studies die zijn meegenomen in deze meta-analyse is het de werkgroep niet duidelijk of de combinatie van paracetamol met een NSAID effectiever is dan paracetamol of een NSAID alleen.

Conclusies

Niveau 1

De combinatie van een NSAID, klassieke en COX-2 specifieke remmers met paracetamol is mogelijk effectiever dan paracetamol of een NSAID alleen.

 

Bronnen (A1 Hyllested et al., 2002; Ong et al., 2010)

Samenvatting literatuur

Hyllested et al., (2002) vergeleken de effectiviteit van paracetamol, NSAID’s en hun combinatie voor postoperatieve pijnbestrijding. Het betreft een analyse van 36 gerandomiseerde studies met 3362 patiënten waarbij alleen klassieke NSAID’s werden geïncludeerd. Een recentere meta-analyse naar de combinatie van paracetamol gecombineerd met NSAID’s (Ong et al., 2010), analyseerde 21 studies met 1909 patiënten en includeerde zowel de klassieke NSAID’s als Cox-2 specifieke remmers. In beide meta-analyses was de combinatie van paracetamol met NSAID’s effectiever dan paracetamol of een NSAID alleen.

Referenties

  1. Adriaensen, H., & Nierinck, P. (1986). Buprenorfine, farmacologie en farmacokinetiek. Pijninformatorium, 1130, 1-9.
  2. Adunsky, A., levy, R., Heim, M., Mizrahi, E., & Arad, M. (2002). Meperidine analgesia and delirium in aged hip fracture patients. Arch Gerontol Geriatr, 35, 253-9.
  3. Akkurt, B.C.O., Inanoglu, K., Kalaci, A., Turhanoglu, S., Asfuroglu, Z., & Tumkaya, F. (2009). Effects of intravenous small dose ketamine and midazolam on postoperatieve pain following knee arthroplasty. Pain Practice, 9 (4), 289-295.
  4. Albrecht, S., Fechner, J., Geisslinger, G., Maass, A.B., Upadhyaya, B., Moecke, H., ... Schuttler, J. (2000). Postoperative pain control following remifentanil-based anaesthesia for major abdominal surgery. Anaesthesia, 55, 315-22.
  5. Ali, M., & Khan, F.A. (2009). Comparison of analgetic effect of tramadol alone and a combination of tramadol and paracetamol in day-care laproscopic surgery. Eur J Anaesth, 26 (40), 333-7.
  6. Anastassopoulos, K.P., Chow, W., Ackerman, S.J., Tapia, C., Benson, C., & Kim, M.S. (2011). Oxycodone-related side effects: Impact on degree of bother, adherence, pain relief, satisfaction, and quality of life. J of Opioïd Management, 7, 203-215.
  7. Andrade, S.E., Martinez, C., & Walker, A.M. (1998). Comparative safety evaluation of non-narcotic analgesics. J Clin Epidemiol, 51, 1357-65.
  8. Andrieu, G., Roth, B., Ousmane, L., Castaner, M., Petillot, P., Vallet, B., ... Lebuffe, G. (2009). The efficacy of intrathecal morphine with or without clonidine for postoperative analgesia after radical prostatectomy. Anesth Analg, 108, 1954-7.
  9. Angst, M.S., & Clark, J.D. (2006). Opioïd-induced hyperalgesia: a qualitative systematic review. Anesthesiology, 104, 570-87.
  10. Armand, S., Langlade, A., Boutros, A., Lobjoit, K., Monrigal, C., Ramboatiana, R., ... Bonnet, F. (1998). Meta-analysis of the efficacy of extradural clonidine to relieve postoperative pain: an impossible task. Br J Anaesth, 81, 126-34.
  11. Atef, A., & Fawaz, A.A. (2008). Intravenous paracetamol is highly effective in pain treatment after tonsillectomy in adults. Eur Arch Otorhinolaryngol, 265, 351-5.
  12. Aubrun, F., Monsel, S., Langeron, O., Coriat, P., & Riou, B. (2001). Postoperative titration of intravenous morphine. Eur J Aneasthesiol, 18, 159-65.
  13. Aveline, C., Gautier, J.F., Vautier, P., Cognet, F., Hetet, H.L., Attali, J.Y., ... Bonnet, F. (2009). Postoperative analgesia and early rehabilitation after total knee replacement: a comparison of continuous low-dose intravenous ketamine versus nefopam. Eur J Pain, 13, 613-619.
  14. Bailey P.L., Lu, J.K., Pace, N.L., Orr, J.A., White, J.L., Hamber, E.A., ... Rollins, D.E. (2000). Effects of intrathecal morphine on the ventilatory respons to hypoxia. N Engl J Med, 343, 1228-34.
  15. Ballantyne, J.C., Carr, D.B., Chalmers, T.C., Dear, K.B., Angelillo, I.F., & Mosteller, F. (1993). Postoperative patient-controlled analgesia: meta-analyses of initial randomized control trials. J Clin Anesth, 5, 182-93.
  16. Bamigbade, T.A., & Langford, R.M. (1998). The clinical use of tramadol hydrochloride. Pain Reviews, 5, 155-182.
  17. Barden, J., Derry, S., McQuay, H.J., & Moore, R.A. (2009). Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults. Cochrane Database Syst, 7 (4), CD007355.
  18. Baron, J.A., Sandler, R.S., Bresalier, R.S., Lanas, A., Morton, D.G., Riddell, R., ... Demets, D.L. (2008). Cardiovascular events associated with rofeCoxib: final analysis of the APPROVe trial. Lancet, 372, 1756-64.
  19. Bastelaere, M. van, Rolly, G., & Abdullah, N.M. (1995). Postoperative Analgesia and plasma levels after transdermal fentanyl for orthopedic surgery: double-blind comparison with placebo. J. Clin Anesth, 7, 26-30.
  20. Battistella, M., Mamdami, M.M., Juurlink, D.N., Rabeneck, L., & Laupacis, A. (2005). Risk of upper gastrointestinal hemorrhage in warfarin users treated with nonselective NSAID’s or COX-2 inhibitors. Arch Intern Med, 165, 189-92.
  21. Bell, J.G., Shaffer, L.E., & Schrickel-Feller, T. (2007). Randomized trial comparing 3 methods of postoperative analgesia in gynecology patients: patient-controlled intravenous, scheduled intravenous, and scheduled subcutaneous. Am J Obstet Gynecol, 197 (472), 1-7.
  22. Bell, R.F., Dahl, J.B., Moore, R.A., & Kalso, E. (2006). Perioperative ketamine for acute postoperative pain (Review). Cochrane Database, 25 (1), CD004603.
  23. Berg, A.A. van den, Honjol, N.M., Prabhu, N.V., Datta, S., Rozario, C.J., Muraleedaran, R., & Savva, D. (1994). Analgesics and ENT surgery. A clinical comparison of the intraoperative, recovery and postoperative effects of buprenorphine, diclofenac, fentanyl, morphine, nalbuphine, pethidine and placebo given intravenously with induction of anaesthesia. Br J Clin Pharmacol, 38 (6), 533-43.
  24. Bernard, J.M., Hommeril, J.L., Passuti, N., & Pinaud, M. (1991). Postoperative analgesia by intravenous clonidine. Anesthesiology, 75, 577-82.
  25. Biki, B., Mascha, E., Moriartry, D.C., Fitzpatrick, J.M., Sessler, D.I., & Buggy, D.J. (2008). Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology, 109, 180-7.
  26. Bilgin, H., Ozcan, B., Bilgin, T., Kerimoglu, B., Uçkunkaya, N., Toker, A., ... Osma, S. (2005). The influence of timing of systemic ketamine administration on postoperative morphine consumption. J Clin Anesthesia, 17, 592-597.
  27. Binning, A.R., Przesmycki, K., Sowinski, P., Morrison, L.M., Smith, T.W., Marcus, P., ... Dahan, A. (2011). A randomised controlled trial on the efficacy and side-effect profile (nausea/vomiting/sedation) of M6G versus morphine for post-operative pain relief after major abdominal surgery. Eur J of Pain, 15, 402-408.
  28. Blaicher, A.M., Landsteiner, H.T., Al-Falaki, O., Zwerina, J., Volf, I., Gruber, D., ... Hoerauf, K. (2004a). Acetylsalicylic acid, diclofenac, and lornoxicam, but not rofeCoxib, affect platelet CD 62 expression. Anesth Analg, 98, 1082-5.
  29. Blaicher, A.M., Landsteiner, H.T., Zwerina, J., Leitgeb, U., Volf, I., & Hoerauf, K. (2004b). Effect of non-selective, non-steroidal anti-inflammatory drugs and cyclo-oxygenase-2 selective inhibitors on the PFA-100 closure time. Anaesthesia, 59, 1100-3.
  30. Blumenthal, S. (2007). Postoperative intravenous morphine consumption, pain scores, and side effects with perioperative oral controlled-release oxycodone after lumbar discetomy. Anaesth Analg, 105, 233-7.
  31. Boezaart, A.P., Eksteen, J.A., Spuy, G.V., Rossouw, P., & Knipe, M. (1999). Intrathecal morphine. Double blind evaluation of optimal dosage for analgesia after major lumbar surgery. Spine, 24, 1131-7.
  32. Böger, R.H. (2006). Renal impairment: a challenge for opioïd treatment? The role of buprenorphine. Palliate Med, 20 (1), 17-23.
  33. Bombardier, C., Laine, L., Reicin, A., Shapiro, D., Burgos-Vargas, R., Davis, B., ... Schnitzer, T.J. (2000). Comparison of upper gastrointestinal toxicity of rofeCoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N Engl J Med, 343, 1520-8.
  34. Bong, C.L., Samuel, M., Ng, J.M., & Ip-Yam, C. (2005). Effects of preemptive epidural analgesia on post-thoracotomy pain. J Cardiothorac Vasc Anesth, 19, 786-93.
  35. Bonnet, M.P., Beloeil, H., Benhamou, D., Mazoit, J.X., & Asehnoune, K. (2008). The mu opioïd receptor mediates morphine-induced tumor necrosis factor and interleukin-6 inhibition in toll-like receptor 2-stimulated monocytes. Anesth Analg, 106, 1142-9.
  36. Bonnet, M.P., Mignon, A., Mazoit, J.X., Ozier, Y., & Marret, E. (2010). Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioïds after elective caesarean section : a systematic review. Eur J of Pain, 14, 894e1-e9.
  37. Boulanger, A., Choiniere, M., Roy, D., Bouré, B., Chartrand, D., Choquette, R., & Rousseau, P. (1993). Comparison between patient-controlled analgesia and intramuscular meperidine after thoracotomy. Can J Anaesth, 40, 409-15.
  38. Bourke, M., Hayes, A., Doyle, M., & McCarroll, M. (2000). A comparison of regularly administered sustained release oral morphine with intramuscular morphine for control of postoperative pain. Anesth Analg, 90 (2), 427-30.
  39. Bozkurt, N., Kurdoglu, M., Kurdoglu, Z., Kutlusoy, F., & Biberoglu, K. (2009). Postoperative pain control after caesarean section: can diclofenac sodium be used instead of meperidine? J Matern Fetal Neon, 22, 114-50.
  40. Braden, G.L., O'Shea, M.H., Mulhern, J.G., & Germain, M.J. (2004). Acute renal failure and hyperkalaemia associated with cyclooxygenase-2 inhibitors. Nephrol Dial Transplant, 19, 1149-53.
  41. Breitfeld, C., Peters, J., Vockel, T., Lorenz, C., & Eikermann, M. (2003). Emetic effects of morphine and piritramide. Br J Anaesth, 91 (2), 218-23.
  42. Bresalier, R.S., Sandler, R.S., Quan, H., Bolognese, J.A., Oxenius, B., Horgan, K., ... Baron, J.A. (2005). Cardiovascular events associated with rofeCoxib in a colorectal adenoma chemoprevention trial. N Engl J Med, 352, 1092-102.
  43. Brok, J., Buckley, N., & Gluud, C. (2006). Interventions for paracetamol (acetaminophen) overdose. Cochrane Database Syst Rev, 19 (2), CD003328.
  44. Cakan, T., Inan, N., Culhaoglu, S., Bakkal, K., & Basar, H. (2008). Intravenous paracetamol improves the quality of postoperative analgesia but does not decrease narcotic requirements. J Neurosurg Anesthesiol, 20, 169-73.
  45. Camu, F. (1996). Side effects of opioïds in postoperative pain treatment. Acta Anaesth Belg, 47, 105-9.
  46. Candido, K.D., Hennes, J., Gonzalez, S., Mikat-Stevens, M., Pinzur, M., Vasic, V., & Knezevic, N.N. (2010). Buprenorphine enhances and prolongs the postoperative analgesic effect of bupivacaine in patients receiving intraglutal sciatic nerve block. Anesthesiology, 113, 1419-1426.
  47. Cannon, C.P., Curtis, S.P., FitzGerald, G.A., Krum, H., Kaur, A., Bolognese, J.A., ... Laine, L. (2006). Cardiovascular outcomes with etoriCoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational EtoriCoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison. Lancet, 368, 1771-81.
  48. Caplan, R.A., Posner, K.L., Ward, R.J., & Cheney, F.W. (1990). Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology, 72, 828-33.
  49. Cardwell, M., Siviter, G., & Smith, A. (2005). Non-steroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy. Cochrane Database Syst Rev, 18 (02), CD003591.
  50. Carr, D., & Goudas, L.C. Acute pain. Lancet, 353, 2051-8.
  51. Carroll, D., Frankland, T., Nagle, C., & McQuay, H. (1993). Oral bromfenac 10 and 25 mg compared with sublingual buprenorphine 0.2 and 0.4 mg for postoperative pain relief. Br J Anaesth, 71 (6), 814-7.
  52. Carstensen, M., & Moller, A.M. (2010). Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain: a qualitative review of randomized trials. Br J Anaesth, 104, 401-6.
  53. Catella-Lawson, F., Reilly, M.P., Kapoor, S.C., Cucchiara, A.J., DeMarco, S., Tournier, B., ... FitzGerald, G.A. (2001). Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med, 345, 1809-17.
  54. Chan, A.K., Cheung, C.W., & Chong, Y.K. (2010a). Alpha-2 agonists in acute pain management. Expert Opin Pharmacother, 11, 2849-68.
  55. Chan, F.K., Hung, L.C., Suen, B.Y., Wu, J.C., Lee, K.C., Leung, V.K., ... Sung, J.J. (2002). CeleCoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis. N Engl J Med, 347, 2104-10.
  56. Chan, F.K., Lanas, A., Scheiman, J., Berger, M.F., Nguyen, H., & Goldstein, J.L. (2010b). CeleCoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR): a randomised trial. Lancet, 376, 173-9.
  57. Chan, F.K., Wong, V.W., Suen, B.Y., Wu, J.C., Ching, J.Y., Hung, L.C., ... Sung, J.J. (2007). Combination of a cyclo-oxygenase-2 inhibitor and a proton-pump inhibitor for prevention of recurrent ulcer bleeding in patients at very high risk: a double-blind, randomised trial. Lancet, 369, 1621-6.
  58. Chang, A.M., Ip, W.Y., & Cheung, T.H. (2004). Patient-controlled analgesia versus conventional intramuscular injection: a cost effectiveness analysis. J Adv Nurs, 46, 531-41.
  59. Charuluxananan, S. (2000). Ondansetron for treatment of ontrathecal morphine-induced pruritus after caesarean delivery. Reg Anesth Pain Med, 25, 535-9.
  60. Chauvin, M., Sandouk, P., Scherman, J.M., Farinotti, R., Strumza, P., & Duvaldestin, P. (1987). Morphine pharmacokinetics in renal failure. Anesthesiology, 66, 327-331.
  61. Cheng, H.F., & Harris, R.C. (2005). Renal effects of non-steroidal anti-inflammatory drugs and selective cyclooxygenase-2 inhibitors. Curr Pharm Des, 11, 1795-804.
  62. Choi, H.J., Little, M.S., Garber, S.Z., & Tremper, K.K. (1989). Pulse oximetry for monitoring during ward analgesia: epidural morphine versus parenteral narcotics. J Clin Monit, 5 (2), 87-9.
  63. Choi, J.H., Lee, J., Choi, J.H., & Bishop, M.J. (2000). Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine. Can. J. Anaesth., 47, 33-7.
  64. Choiniere, M., Rittenhouse, B.E., Perreault, S., Chartrand, D., Rousseau, P., Smith, B., & Pepler, C. (1998). Efficacy and costs of patient controlled analgesia versus regularly administered intramuscular opioïd therapy. Anesthesiology, 89 (6), 1377-88.
  65. Christensen, K., Rogers, E., Green, G.A., Hamilton, D.A., Mermelstein, F., Liao, E., ... Carr, D.B. (2007). Safety and efficacy of intranasal ketamine for acute postoperative pain. Acute Pain, 9, 183-192.
  66. Chui, P.T., & Gin, T. (1992). A double blind randomized trial comparing postoperative analgesia after perioperative loading doses of methadone or morphine. Anaesth Intensive Care, 20, 46-51.
  67. Chumbley, G.M., Hall, G.M., & Salmon, P. (1999). Why do patients feel positive about patient-controlled analgesia? Anaesthesia, 54, 386-9.
  68. Chumbley, G.M., Ward, L., Hall, G.M., & Salmon, P. (2004). Pre-operative information and patient-controlled analgesia: much ado about nothing. Anaesthesia, 59, 354-8.
  69. Clarke, H., Pereira, S., Kennedy, D., ... (2009a). Adding gabapentin to a multimodal regimen does not reduce acute pain, opioïd consumption or chronic pain after total hip arthroplasty. Acta Anaesthesiol Scand, 53, 1073-83.
  70. Clark, H., Bonin, R.P., Orser, B.A., Englesakis, M., Wijeysundera, D.N., & Katz, J. (2012). The prevention of chronic postsurgical pain using gabapentin en pregabalin: a combined systemic review and meta-analysis. Anesth Analg, 115, 428-442.
  71. Cobby, T.F., Crighton, I.M., Kyriakides, K., & Hobbs, G.J. (1999). Rectal paracetamol has a significant morphine-sparing effect after hysterectomy. Br J Anaesth, 83, 253-6.
  72. Cokefair, A., Smith, H.S., & Gries, C.A. (1996). An investigation of the current literature on the effectiveness of patient-controlled analgesia methods. Crna, 7, 126-34.
  73. Colbert, S., O'Hanlon, D.M., Galvin, S., Chambers, F., & Moriarty, D.C. (1999). The effect of rectal diclofenac on pruritus in patients receiving intrathecal morphine. Anaesthesia, 54, 948-52.
  74. Cole, P.J., Craske, D.A., & Wheatley, R.G. (2000). Efficacy and respiratory effects of low-dose spinal morphine for postoperative analgesia following knee arthroscopy. Br. J. Anaesth., 85, 233-7.
  75. Collins, S.L., Edwards, J.E., Moore, R.A., & McQuay, H.J. (2001). Single dose dextropropoxyphene alone and with paracetamol (acetominophen) for postoperative pain (Cochrane review). Cochrane Database Syst Rev., 2000 (2), CD001440.
  76. Cook, R.J., & Sackett, D.L. (1995). The number needed to treat: a clinically useful measure of treatment effect. Bmj, 310, 452-4.
  77. Cooper, I.M. (1996). Morphine for postoperative analgesia. A comparison of intramuscular and subcutaneous routes of administration. Aneaesth Intensive Care, 24 (5), 574-8.
  78. Dahan, A. (2006a). Opioïd-induced respiratory effects: new data on buprenorphine. Palliat Med, 20, 3-8.
  79. Dahan, A., Aarts, L., & Smith, T.W. (2010). Incidence, Reversal, and Prevention of opioïd-induced respiratory depression. Anesthesiology, 112, 226-38.
  80. Dahan, A., Yassen, A., Romberg, R., Sarton, E., Teppema, L., Olofsen, E., & Danhof, M. (2006b). Buprenorphine induces ceiling in respiratory depression but not in analgesia. Br J Anaesth, 96, 627-32.
  81. Dahl, J.B., Daugaard, J.J., Larsen, H.V., Mouridsen, P., Nielsen, T.H., & Kristoffersen, E. (1987). Patient-controlled analgesia: a controlled trial. Acta Anaesthesiol Scand, 31, 744-7.
  82. Davis, K.M., Esposito, M.A., & Meyer, B.A. (2006a). Oral analgesia compared with intravenous patient-controlled analgesia for pain after cesarean delivery : a randomized controlled trial. Am j Obst and Gyn, 194, 967-71.
  83. Davis, K.M., Esposito, M.A., Meyer, B.A. (2006b). Oral analgesia compared with intravenous patient-controlled analgesia for pain after cesarean delivery: a randomized controlled trial. Am J Obstet Gynecol, 194, 967-71.
  84. Dawson, L., Brockbank, K., Carr, E.C., & Barrett, R.F. (1999). Improving patients postoperative sleep: a randomized control study comparing subcutaneous with intravenous patient controlled analgesia. J Adv Nurs, 30 (4), 875-81.
  85. Deegan, C.A., Murray, D., Doran, P., Ecimovic, P., Moriarty, D.C., & Buggy, D.J. (2009). Effect of anaesthetic technique on oestrogen receptor-negative breast cancer cell function in vitro. Br J Anaesth, 103, 685-90.
  86. Dejonckheere, M., Levarlet, M., & D'Hollander, A. (1993). Intramuscular buprenorphine for pain relief after abdominal surgery: a comparison between on-demand and prophylactic administration. Eur J Anaesthesiol, 10 (4), 291-5.
  87. Derry, C., Derry, S., Moore, R.A., & McQuay, H.J. (2009a). Single dose oral ibuprofen for acute postoperative pain in adults. Cochrane Database Syst Rev, 8 (3), CD001548.
  88. Derry, C., Derry, S., Moore, R.A., & McQuay, H.J. (2009b). Single dose oral naproxen and naproxen sodium for acute postoperative pain in adults. Cochrane Database Syst Rev, 21 (1) CD004234.
  89. Derry, P., Derry, S., Moore, R.A., & McQuay, H.J. (2009c). Single dose oral diclofenac for acute postoperative pain in adults. Cochrane Database Syst Rev, 15 (2), CD004768.
  90. Derry, S., Barden, J., McQuay, H.J., & Moore, R.A. (2008). Single dose oral celeCoxib for acute postoperative pain in adults. Cochrane Database Syst Rev, 8 (4), CD004233.
  91. Discombe, G. (1952). Agranulocytosis caused by amidopyrine; an avoidable cause of death. Br Med J, 1, 1270-3.
  92. Dopfmer, U.R., Schenk, M.R., Kuscic, S., Beck, D.H., Dopfmer, S., & Kox, W.J. (2001). A randomized controlled double blind trial comparing piritramide and morphine for analgesia after hysterectomy. Eur J Anaesthesiol, 18 (6), 389-93.
  93. Droney, J. Levy, J., & Quigley, C. (2007). Prescribing opioïds in renal failure. J Opioïd Management, 3, 309-15.
  94. Duggan, S.T., & Scott, L.J. (2009). Intravenous paracetamol (acetaminophen). Drugs, 69, 101-13.
  95. Edwards, J., Meseguer, F., Faura, C., Moore, R.A., McQuay, H.J., & Derry, S. (2010). Single dose dipyrone for acute postoperative pain. Cochrane Database Syst Rev, 8 (9), CD003227.
  96. Edwards, J.E., McQuay, H.J., & Moore, R.A. (2002). Combination Analgesic efficacy: individual patient data meta-analysis of single-dose oral tramadol plus acetaminophen in acute postoperative pain. J of Pain and Symptom mang, 23, 121-130.
  97. Edwards, J.E., Loke, Y.K., Moore, R.A., & McQuay, H.J. (2000a). Single dose piroxicam for acute postoperative pain. Cochrane Database Syst Rev, 2000 (4), CD002762.
  98. Edwards, J.E., McQuay, H.J., & Moore, R.A. (2000c). Single dose dihydrocodeine for postoperative pain (Cochrane review). In: The Cochrane Library, 4, CD002760.
  99. Edwards, J.E., Moore, R.A., & McQuay, H.J. (2000d). Single dose oxycodone and oxycodone plus paracetamol (acetominophen) for acute postoperative pain (Cochrane review). In: The Cochrane Library, 4, CD002763.
  100. Edwards, J.E., Oldman, A., Smith, L., Collins, S.L., Carroll, D., Wiffen, P.J., ... Moore, R.A. (2000b). Single dose oral aspirin for acute pain. Cochrane Database Syst Rev, 2000 (2), CD002067.
  101. Egbert, A.M. (1996). Postoperative pain management in the frail elderly (review). Clin Geriatr Med, 12 (3), 583-99.
  102. Egbert, A.M., Parks, L.H., Short, L.M., & Burnett, M.L. (1990). Randomized trial of postoperative patient controlled analgesia vs intramuscular narcotics in frail elderly men. Arch Intern Med, 150 (9), 1897-903.
  103. Elborne, D., & Wiseman, R.A. (2000). Types of intra-muscular opioïds for maternal pain relief in labour (Cochrane review). In: The Cochrane Library, 2, CD001237.
  104. Elhakim, M., Fathy, A., Amine, H., Saeed, A., & Mekawy, M. (2000). Effect of i.v. tenoxicam during caesarean delivery on platelet activity. Acta Anaesthesiol Scand, 44, 555-9.
  105. Elia, N., ... (2005). Ketamine and postoperative pain – a quantitative systematic review of randomised trials. Pain, 13, 61-70.
  106. Elia, N., Culebras, X., Mazza, C., Schiffer, E., & Tramer, M.R. (2008). Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials. Reg Anesth Pain Med, 33, 159-67.
  107. Etminan, M., Sadatsafavi, M., Jafari, S., Doyle-Waters, M., Aminzadeh, K., & Fitzgerald, J.M. (2009). Acetaminophen use and the risk of asthma in children and adults: a systematic review and metaanalysis. Chest, 136, 1316-23.
  108. Ezri, T., Lurie, S., Stein, A., Evron, S., & Geva, D. (2002). Postoperative nausea and vormiting: comparison of the effect of postoper meperidine or morphine in gynaecologic surgery patients. J Clin Anesth, 14, 262-6.
  109. Faura, C.C., Collins, S.L., Moore, R.A., & McQuay, H.J. (1998) Systematic review of factors affecting the ratios for morphine and its major metabolites. Pain, 74, 43-53.
  110. Feenstra, J., Grobbee, D.E., Remme, W.J., & Stricker, B.H. (1999). Drug-induced heart failure. J Am Coll Cardiol, 33, 1152-62.
  111. Ferraris, V.A., Ferraris, S.P., Joseph, O., Wehner, P., & Mentzer, R.M., (2002). Aspirin and postoperative bleeding after coronary artery bypass grafting. Ann Surg, 235, 820-7.
  112. Filitz, J., Griessinger, N., Sittl, R., Likar, R., Schüttler, J., & Koppert, W. (2006). Effects of intermittent hemodialysis on buprenorhine and norbuprenorphine plasma concentrations in chronic pain patients treated with transdermal buprenorphine. Eur J of Pain, 10, 743-8.
  113. Fong, H.K., Sands, L.P., & Leung, J.M. (2006). The role of postoperative analgesia in delirium and cgnitive decline in elderly patients: a systematic review. Anesth Analg, 102, 1255-66.
  114. Forget, P., Vandenhende, J., Berliere, M., Machiels, J.P., Nussbaum, B., Legrand, C., & Kock, M. de (2010). Do intraoperative analgesics influence breast cancer recurrence after mastectomy? A retrospective analysis. Anesth Anal, 110, 1630-5.
  115. Forman, W.B. (1996). Opioïd analgesic drugs in the elderly (review). Clin Geriatr Med, 12 (3), 489-500.
  116. Gabbott, D.A., Cohen, A.M., Mayor, A.H., Niemiro, L.A., & Thomas, T.A. (1997). The influence of timing of ketorolac administration on post-operative analgesic requirements following total abdominal hysterectomy. Eur J Anaesthesiol, 14, 610-5.
  117. Gabriel, S.E., Jaakkimainen, L., & Bombardier, C. (1991). Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med, 115, 787-96.
  118. Gaitini, L., Moskovitz, B., Katz, E., Vaisberg, A., Vaida, S., & Nativ, O. (1996). Sublingual buprenorphine compared to morphine delivered by a patient-controlled analgesia system as postoperative analgesia after prostatectomy. Urologia Internationalis, 57 (4), 227-9.
  119. Garcia Rodriguez, L.A., & Jick, H. (1994). Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Lancet, 343, 769-72.
  120. Garcia Rodriguez, L.A., Cattaruzzi, C., Troncon, M.G., & Agostinis, L. (1998). Risk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac, other nonsteroidal anti-inflammatory drugs, calcium antagonists, and other antihypertensive drugs. Arch Intern Med, 158, 33-9.
  121. Gaskell, H., Derry, S., Moore, R.A., & McQuay, H.J. (2009). Single dose oral oxycodone and oxycodone plus paracetamol (acetaminophen) for acute postoperative pain in adults (review). Cochrane database of systematic reviews, 8 (3), CD002763.
  122. Gehling, M., & Tryba, M. (2009). Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia, 64 (6), 643-51.
  123. George, J.A., Lin, E.E., Hanna, M.N., Murphy, J.D., Kumar, K., Ko, P.S., & Wu, C.L. (2010). The effect of intravenous opioïd patient-controlled analgesia with and without background infusion on respiratory depression: a meta-analysis. J Opioïd Manag, 6, 47-54.
  124. Gilron, I. (2007). Gabapentin and pregabalin for chronic neuropathic and early postsurgical pain: current evidence and future directions. Curr Opin Anaesthesiol, 20, 456-72.
  125. Gislason, G.H., Rasmussen, J.N., Abildstrom, S.Z., Schramm, T.K., Hansen, M.L., Fosbøl, E.L., ... Torp-Pedersen, C. (2009). Increased mortality and cardiovascular morbidity associated with use of nonsteroidal anti-inflammatory drugs in chronic heart failure. Arch Intern Med, 169, 141-9.
  126. Glassman, S.D., Rose, S.M., Dimar, J.R., Puno, R.M., Campbell, M.J., & Johnson, J.R. (1998). The effect of postoperative nonsteroidal anti-inflammatory drug administration on spinal fusion. Spine (Phila Pa 1976), 23, 834-8.
  127. Gopinathan, C., Sockalingham, I., Fung, M.A., Peat, S., & Hanna, M.H. (2000). A comparative study of patient controlled epidural diamorphine, subcutaneous diamorphine and an epidural diamorphine/bupivacaine combination for postoperative pain. Eur J Anaesthesiol, 17 (3), 189-96.
  128. Gottschalk, A., Durieux, M.E., & Nemergut, E.C. (2011). Intraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery. Anesth Analg, 122, 218-223
  129. Graham, D.Y., Agrawal, N.M., Campbell, D.R., Haber, M.M., Collis, C., Lukasik, N.L., & Huang, B. (2002). Ulcer prevention in long-term users of nonsteroidal anti-inflammatory drugs: results of a double-blind, randomized, multicenter, active- and placebo-controlled study of misoprostol vs lansoprazole. Arch Intern Med, 162, 169-75.
  130. Grape, S., & Tramer, M.R. (2007). Do wij need preemptive analgesia for the treatment of postoperative pain? Best Pract Res Clin Anaesthesiol, 21, 51-63.
  131. Grass, J.A. (2005). Patient-controlled analgesia. Anesth Analg, 101, S44-61.
  132. Grass, J.A., Sakima, N.T., Valley, M., Fischer, K., Jackson, C., Walsh, P., & Bourke, D.L. (1993). Assessment of ketarolac as an adjuvant to fentanyl patient-controlled analgesia after radical retropubic prostatectomy. Anesthesiology, 78, 642-8.
  133. Grond, S. (2004). Sablotzki A. Clinical pharmacology of tramadol. Clin. Pharmacokinetic, 43 (13), 879-923.
  134. Grond, S., Radbruch, L., & Lehman, K.A. (2000). Clinical Pharmacokinetics of transdermal opioïds: focus on transdermal fentanyl. Clin Pharmacokinetic, 38 (1), 59-89.
  135. Guillou, N., Tanguy, M., Seguin, P., Branger, B., Campion, J.P., & Mallédant, Y. (2003). The effects of small-dose ketamine on morphine consumption in surgical intensive care unit patients after major abdominal surgery. Anaesth Analg, 2003, 843-7.
  136. Gunter, J.B., Varughese, A.M., Harrington, J.F., Wittkugel, E.P., Patankar, S.S., Matar, M.M., Willging, J.P. (1995). Recovery and complications after tonsillectomy in children: a comparison of ketorolac and morphine. Anesth Analg, 81, 1136-41.
  137. Gust, R., Pecher, S., Gust, A., Hoffmann, V., Bohrer, H., & Martin, E. (1999). Effect of patient-controlled analgesia on pulmonary complications after coronary artery bypass grafting. Crit Care Med, 27, 2218-23.
  138. Hagle, M.E., Lehr, V.T., Brubakken, K., & Shippee, A. (2004). Respiratory depression in adult patients with intravenous patient-controlled analgesia. Orthop Nurs, 23, 18-27.
  139. Hand, C.W., Sear, J.W., Uppington, J., Ball, M.J., McQuay, H.J., & Moore, H.A. (1990). Buprenorphine disposition in patients with renal impairment: single and continuous dosing, with special reference to metabolites. Br J Anaesth, 64 (3), 276-82.
  140. Harley, E.H., & Dattolo, R.A. (1998). Ibuprofen for tonsillectomy pain in children: efficacy and complications. Otolaryngol Head Neck Surg, 119, 492-6.
  141. Hasselstrom, J., & Sawe, J. (1993). Morphine pharmacokinetics and metabolism in humans. Clin Pharmacokinetics, 24, 344-54.
  142. Hawkey, C.J., Karrasch, J.A., Szczepanski, L., Walker, D.G., Barkun, A., Swannell, A.J., & Yeomans, N.D. (1998). Omeprazole compared with misoprostol for ulcers associated with nonsteroidal antiinflammatory drugs. Omeprazole versus Misoprostol for NSAID-induced Ulcer Management (OMNIUM) Study Group. N Engl J Med, 338, 727-34.
  143. Heard, K.J. (2008). Acetylcysteine for acetaminophen poisoning. N Engl J Med, 359, 285-92.
  144. Hedenmalm, K., & Spigset, O. (2002). Agranulocytosis and other blood dyscrasias associated with dipyrone (metamizole). Eur J Clin Pharmacol, 58, 265-74.
  145. Hegi, T.R., Bombeli, T., Seifert, B., Baumann, P.C., Haller, U., Zalunardo, M.P., ... Spahn, D.R. (2004). Effect of rofeCoxib on platelet aggregation and blood loss in gynaecological and breast surgery compared with diclofenac. Br J Anaesth, 92, 523-31.
  146. Hein, A., Rösblad, P., Gillis-Haegerstrand, C., Schedvins, K., Jakobsson, J., & Dahlgren, G. (2012). Low dose intrathecal morphine effects on post-hysterectomy pain: a randomized placebo-controlled study. Acta Anaesthesiol Scand, 56, 102-109
  147. Henry, D., Lim, L.L., Garcia Rodriguez, L.A., Perez Gutthann, S., Carson, J.L., Griffin, M., ... Fries, J.T. (1996). Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. Bmj, 312, 1563-6.
  148. Hernandez-Diaz, S., & Rodriguez, L.A. (2000). Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the 1990s. Arch Intern Med, 160, 2093-9.
  149. Himmelseher, S., & Durieux, M.E. (2005). Ketamine for perioperative pain management. Anesthesiology, 102, 211-20
  150. Ho, H.S. (2008). Patient-controlled analgesia versus oral controlled release oxycodone – are they interchangeable for acute postoperative pain after laparoscopic colorectal surgeries? Oncology, 74 (1), 61-65.
  151. Hocking, G., Visser, E.J., Schug, S.A., & Cousins, M.J. (2007). Ketamine: does life begin at 40? Clinical Update, International Association for the study of pain, 15 (3), 1-6.
  152. Hoigne, R., Zoppi, M., Sollberger, J., Hess, T., & Fritschy, D. (1986). Fall in systolic blood pressure due to metamizol (dipyrone, noramidopyrine, novaminsulfone). Results from the Comprehensive Hospital Drug Monitoring Berne (CHDMB). Agents Actions Suppl, 19, 189-95.
  153. Huang, Y.M., Wang, C.M., Wang, C.T., Lin, W.P., Horng, L.C., & Jiang, C.C. (2008). Perioperative celeCoxib administration for pain management after total knee arthroplasty - a randomized, controlled study. BMC Musculoskelet Disord, 9, 77.
  154. Hudcova, J., McNicol, E., Quah, C., Lau, J., & Carr, D.B. (2006). Patient controlled opioïd analgesia versus conventional opioïd analgesia for postoperative pain. Cochrane Database Syst Rev, 18 (4) CD003348.
  155. Huguley, C.M., (1964). Agranulocytosis Induced by Dipyrone, a Hazardous Antipyretic and Analgesic. Jama, 189, 938-41.
  156. Hyllested, M., Jones, S., Pedersen, J.L., & Kehlet, H. (2002). Comparative effect of paracetamol, NSAID’s or their combination in postoperative pain management: a qualitative review. Br J Anaesth, 88, 199-214.
  157. Ibanez, L., Vidal, X., Ballarin, E., & Laporte, J.R. (2005). Agranulocytosis associated with dipyrone (metamizol). Eur J Clin Pharmacol, 60, 821-9.
  158. Jahr, J.S., & Lee, V.K. (2010). Intravenous acetaminophen. Anesthesiol Clin, 28, 619-45.
  159. Jenssen, L.J., Handberg, G., Helbo-Hansen, H.S., Skaarup, I., Lohse, T., Munk, T., & Lund, N. (2008). No morphine sparing effect of ketamine added to morphine for patient-controlled intravenous analgesia after uterine artery embolization. Acta Anaesthesiol Scand, 52, 479-486.
  160. Jokela, R., Ahonen, J., Seitsonen, E., Marjakangas, P., & Korttila, K. (2010). The influence of ondansetron on the analgesic effect of acetaminophen after laparoscopic hysterectomy. Clin Pharmacol Ther, 87, 672-8.
  161. Jorgensen, H., Wetterslev, J., Moiniche, S., & Dahl, J.B. (2000). Epidural local anaesthetics versus opioïd-base analgesic regimens on postoperative paralysis, PONV and pain after abdominal surgery (Cochrane review). In: The Cochrane Library, 2000 (4), CD001893.
  162. Juhlin-Dannfelt, M., Adamsen, S., Olvon, E., Beskow, A., & Brodin, B. (1995). Premedication with sublingual buprenorphine for out-patient arthroscopy: reduced need for postoperative pethidine but higher incidence of nausea. Acta Anaesthesiol Scand, 39 (5), 633-6.
  163. Juni, P., Nartey, L., Reichenbach, S., Sterchi, R., Dieppe, P.A., & Egger, M. (2004). Risk of cardiovascular events and rofeCoxib: cumulative meta-analysis. Lancet, 364, 2021-9.
  164. Katz, J., Cohen, L., Schmid, R., Chan, V.W., & Wowk, A. (2003). Postoperative morphine use and hyperalgesia are reduced by preoperative but not intraoperative epidural analgesia: implications for preemptive analgesia and the prevention of central sensitization. Anesthesiology, 98, 1449-60.
  165. Katz, J., Schmid, R., Snijdelaar, D.G., Coderre, T.J., McCartney, C.J., & Wowk, A. (2004). Pre-emptive analgesia using intravenous fentanyl plus low-dose ketamine for radical prostatectomy under general anesthesia does not produce short-term or long-term reductions in pain or analgesic use. Pain, 110, 707-18.
  166. Kearney, P.M., Baigent, C., Godwin, J., Halls, H., Emberson, J.R., & Patrono, C. (2006). Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. Bmj, 332, 1302-8.
  167. Kehlet, H. (1997). Multimodal approach tot control postoperative pathofysiology and rehabilitation. Br. J. Anaesthesia, 78, 606-17.
  168. Kehlet, H. (1998). Modification of Responses to Surgery by Neural Blockade: Clinical Implicarions. In: Cousins MJ, Bridenbaugh PO (eds). Neural blockade in clinical anesthesia and management of pain, 3rd ed. (129-178) Philadelphia: Lippincott-Raven Publishers.
  169. Kehlet, H., Rung, G.W., & Callesen, T. (1996). Postoperative opioïd analgesia: time for a reconsideration? J Clin Anesth, 8 (6), 441-5.
  170. Keita, H., Geachan, N., Dahmani, S., Couderc, E., Armand, C., Quazza, M., ... Desmonts, J.M. (2003). Comparison between patient-controlled analgesia and subcutaneous morphine in elderly patients after total hip replacement. Br J Anaesth, 90, 53-7.
  171. Kelly, D.J., Ahmad, M., & Brull, S.J. (2001). Preemptive analgesia II: recent advances and current trends. Can J Anaesth, 48, 1091-101.
  172. Kelly, J.P., Kaufman, D.W., & Shapiro, S. (1991. Risks of agranulocytosis and aplastic anemia in relation to the use of cardiovascular drugs: The International Agranulocytosis and Aplastic Anemia Study. Clin Pharmacol Ther, 49, 330-41.
  173. Kemppainen, T., Kokki, H., Tuomilehto, H., Seppa, J., & Nuutinen, J. (2006). Acetaminophen is highly effective in pain treatment after endoscopic sinus surgery. Laryngoscope, 116, 2125-8.
  174. Kerr, D.J., Dunn, J.A., Langman, M.J., Smith, J.L., Midgley, R.S., Stanley, A., ... McConkey, C.C, (2007). RofeCoxib and cardiovascular adverse events in adjuvant treatment of colorectal cancer. N Engl J Med, 357, 360-9.
  175. Kietzmann, D., Bouillon, T., Hamm, C., Schwabe, K., Schenk, H., Gundert-Remy, U., & Kettler, D. (1997). Pharmacodynamic modelling of the analgesic effects of piritramide in postoperative patients. Acta Anaesthiol Scand, 41, 888-94.
  176. Kock, M.F. de, Pichon, G., & Scholtes, J.L. (1992). Intraoperative clonidine enhances postoperative morphine patient-controlled analgesia. Can J Anaesth, 39, 537-44.
  177. Korkmaz Dilmen, O., Tunali, Y., Cakmakkaya, O.S., Yentur, E., Tutuncu, A.C., Tureci, E., & Bahar, M. (2010). Efficacy of intravenous paracetamol, metamizol and lornoxicam on postoperative pain and morphine consumption after lumbar disc surgery. Eur J Anaesthesiol, 27, 428-32.
  178. Kornfeld, H., Manfredi, L. (2010). Effectiveness of full agonists opioïds in patients stabilized on buprenorphine undergoing major surgery: a case series. Am J of Ther, 17, 523-528.
  179. Koster, H.T., Avis, H.J., Stevens, M.F., & Hollman, M.W. (2001). Metamizol. Internist (Berl)., 42 (6), 905-9.
  180. Kress, H.G. (2009). Clinical update on the pharmacology, efficacy and safety of transdermal buprenorphine. Eur J of Pain, 13, 219-230.
  181. Kucukemre, F., Kunt, N., Kaygusuz, K., Kiliccioglu, F., Gurelik, B., & Cetin, A. (2005). Remifentanil compared with morphine for postoperative patient-controlled analgesia after major abdominal surgery: a randomized controlled trial. Eur J Anaesthesiol, 22, 378-85.
  182. Kurth, T., Glynn, R.J., Walker, A.M., Chan, K.A., Buring, J.E., Hennekens, C.H., & Gaziano, J.M. (2003). Inhibition of clinical benefits of aspirin on first myocardial infarction by nonsteroidal antiinflammatory drugs. Circulation, 108, 1191-5.
  183. Kwok, R.F., Lim, J., Chan, M.T., Gin, T., & Chiu, W.K. (2004). Preoperative ketamine improves postoperative analgesia after gynaecological laparascopic surgery. Anaesth Analg, 98, 1044-9.
  184. Lacoste, L., Thomas, D., Kraimps, J.L., Chabin, M., Ingrand, P., Barbier, J., & Fusciardi, J. (1997). Postthyroidectomy analgesia: morphine, buprenorphine, or bupivacaine? J Clin Anesth, 9 (3), 189-93.
  185. Lahtinen, P., Kokki, H., Hakala, T., & Hynynen, M. (2004). S(+)-ketamine as an analgesic adjunct reduces opioïd consumption after cardiac surgery. Anaesth Analg, 99, 1295-1301.
  186. Lanas, A., Garcia-Rodriguez, L.A., Arroyo, M.T., Gomollón, F., Feu, F., González-Pérez, A., ... Piqué, J.M. (2006). Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut, 55, 1731-8.
  187. Langman, M.J., Weil, J., Wainwright, P., Lawson, D.H., Rawlins, M.D., Logan, R.F., ... Colin-Jones, D.G. (1994). Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. Lancet, 343, 1075-8.
  188. Laporte, J.R., Carne, X., Vidal, X., Moreno, V., & Juan, J. (1991). Upper gastrointestinal bleeding in relation to previous use of analgesics and non-steroidal anti-inflammatory drugs. Catalan Countries Study on Upper Gastrointestinal Bleeding. Lancet, 337, 85-9.
  189. Laur, D.F., Sinkovich, J., & Betley, K. (1995). A comparison of intraoperative morphine sulfate and methadone hydrochloride on postoperative visual analogue scale pain scores and narcotic requirements. CRNA, 6, 21-5.
  190. Lavand’Homme, P., & Kock, M. de (1998). Practical guidelines on the postoperative use of patient controlled analgesia in the elderly. Drugs Aging, 13 (1), 9-16.
  191. Lavand'homme, P., Kock, M. de, & Waterloos, H. (2005). Intraoperative epidural analgesia combined with ketamine provides effective preventive analgesia in patients undergoing major digestive surgery. Anesthesiology, 103, 813-20.
  192. Lee, A., Cooper, M.G., Craig, J.C., Knight, J.F., & Keneally, J.P. (2007). Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function. Cochrane Database Syst Rev, 18 (2), CD002765.
  193. Lehmann, L.J., DeSio, J.M., Radvany, T., Bikhazi, G.B. (1997). Transdermal fentanyl in postoperative pain. Reg Anesth, 22 (1), 24-8.
  194. Lejus, C., Blanloeil, Y., Francois, T., Testa, S., Michel, P., & Dixneuf, B. (1996). Post-operative intravenous continuous analgesia: comparison of buprenorphine, fentanyl and nalbuphine. Eur J Anaesthesiol, 13 (1), 57-65.
  195. Lersberghe, C. van, Camu, F., Keersmaecker, E. de, & Sacré, S. (1994). Continuous administration of fentanyl for postoperative pain: a comparison of the epidural, intravenous, and transdermal routes. J Clin Anesth, 6, 308-314.
  196. Levine, A.M., & Burdick, R.K. (2005). Controlled-release oxycodone. J Am Acad Orthop Surg, 12, 1-4.
  197. Lewis, S.C., Langman, M.J., Laporte, J.R., Matthews, J.N., Rawlins, M.D., & Wiholm, B.E. (2002). Dose-response relationships between individual nonaspirin nonsteroidal anti-inflammatory drugs (NANSAID’s) and serious upper gastrointestinal bleeding: a meta-analysis based on individual patient data. Br J Clin Pharmacol, 54, 320-6.
  198. Liang, C.C., Chang, S.D., Wong, S.Y., Chang, Y.L., & Cheng, P.J. (2010). Effects of postoperative analgesia on postpartum urinary retention in women undergoing caesarean delivery. J Obstet Gynaecol Res, 36 (5), 991-5.
  199. Liu, N., Kuhlman, G., Dalibon, N., Moutafis, M., Levron, J.C., & Fischler, M. (2001). A randomized double-blinded comparison of intrathecal morphine, sufentanil and their combinationn versus IV morphine patient-controlled analgesia for post-thoracotomy pain. Anesth. Analg., 92, 31-6.
  200. Liu, S.S., Carpenter, R.L., Mackey, D.C., Thirlby, R.C., Rupp, S.M., Shine, T.S., ... Smith, S.L. (1995). Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology, 83 (4), 757-65.
  201. Lloyd, R., Derry, S., Moore, R.A., & McQuay, H.J. (2009). Intravenous or intramuscular pareCoxib for acute postoperative pain in adults. Cochrane Database Syst Rev, 15 (2), CD004771.
  202. Loboz, K.K., & Shenfield, G.M. (2005). Drug combinations and impaired renal function -- the 'triple whammy'. Br J Clin Pharmacol, 59, 239-43.
  203. Looi-Lyons, L.C., Chung, F.F., Chan, V.W., & McQuestion, M. (1996). Respiratory depression: an adverse outcome during patient controlled analgesia therapy. J Clin Anesth, 8, 151-6.
  204. MacDonald, T.M., & Wei, L. (2003). Effect of ibuprofen on cardioprotective effect of aspirin. Lancet, 361, 573-4.
  205. MacDonald, T.M., Morant, S.V., Robinson, G.C., Shield, M.J., McGilchrist, M.M., Murray, F.E., & McDevitt, D.G. (1997). Association of upper gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort study. Bmj, 315, 1333-7.
  206. MacIntyre, P.E., & Jarvis, D.A. (1996). Age is the best predictor of postoperative morphine requirements. Pain, 64, 357-64.
  207. Macintyre, P.E., Loadsman, J.A., & Scott, D.A. (2011). Opioïds, ventilation and acute pain management. Anaesth Intensive Care, 3994, 545-58.
  208. Maj, S., & Centkowski, P. (2004). A prospective study of the incidence of agranulocytosis and aplastic anemia associated with the oral use of metamizole sodium in Poland. Med Sci Monit, 10, PI93-5.
  209. Marcus, H.E., Fabian, A., Dagtekin, O., Schier, R., Krep, H., Bottiger, B.W., ... Petzke, F. (2011). Pain, postdural puncture headache, nausea, and pruritis after caesarean delivery: a survey of prophylaxis and treatment. Minerva Anesthesiol, 77 (11), 1043-9.
  210. Marinangeli, F., Ciccozzi, A., Donatelli, F., Pietro, A. di, Iovinelli, G., Rawal, N., ... Varrassi, G. (2002). Clonidine for treatment of postoperative pain: a dose-finding study. Eur J Pain, 6, 35-42.
  211. Marret, E., Kudri, O., Zufferey, P., & Bonnet, F. (2005). Effects of nonsteroidal anti-inflammatory drugs on patient-controlled analgesia morphine side effects. Anesthesiology, 102, 1249-60.
  212. Mason, L., Edwards, J., Moore, R.A., & McQuay, H.J. (2004). Single dose oral indometacin for the treatment of acute postoperative pain. Cochrane Database Syst Rev, 18 (4), CD004308.
  213. Mattia, C., Coluzzi, F., Sonnino, D., & Anker-Møller, E. (2010). Efficacy and safety of fentanyl HCl iontophoretic transdermal system compared with morphine intravenous patient-controlled analgesia for postoperative pain management. Eur J Anesthesiol, 27, 433-440.
  214. Maund, E., Mcdaid, C., Rice, S., Wright, K., Jenkins, B., & Woolaccott, N. (2011). Paracetamol and selective and non-selective NSAID’s for the reduction in morphine-related side-effects after major surgery: a systematic review. Britisch Journal of Anaesthesia, 106 (3), 292-7.
  215. McArdle, C.S. (1986). Continuous and patient controlled analgesic infusions. In: Doyle, eds. 1986 International Symposium on Pain Control. Royal Society of Medicine International Congress and Symposium Series, 123, 17-23.
  216. McCance-Katz, E.F., Marek, K.L., & Price, L.H. (1992). Serotonergic dysfunction in depression associated with Parkinson's disease. Neurology, 42, 1813-4.
  217. McCartney, C.J., Duggan, E., & Apatu, E. (2007). Should wij add clonidine to local anesthetic for peripheral nerve blockade? A qualitative systematic review of the literature. Reg Anesth Pain Med, 32, 330-8.
  218. McCartney, C.J., Sinha, A., & Katz, J. (2004). A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia. Anesth Analg, 98, 1385-400.
  219. McDaid, C., Maund, E., Rice, S., Wright, K., Jenkins, B., & Woolacott, N. (2010). Paracetamol and selective and non-selective NSAID’s for the reduction in morphine-related side-effects after major surgery: a systematic review. Health Technology Assessment, 14 (17), 1-153.
  220. McDonnell, N.J. Paech, M.J., Browning, R.M., & Nathan, E.A. (2010). A randomised comparison of regular oral oxycodone and intrathecale morphine for post-caesarean analgesia. Int j Obst Anesthesia, 19, 16-23.
  221. McGettigan, P., & Henry, D. (2006). Cardiovascular risk and inhibition of cyclooxygenase: a systematic review of the observational studies of selective and nonselective inhibitors of cyclooxygenase 2. Jama, 296, 1633-44.
  222. McQuay, H., & Edwards, J. (2003). Meta-analyse of single-dose oral tramadol plus acetaminophen in acute postoperative pain. Eur J of Anaesth, 20 (28), 19-22.
  223. McQuay, H.J. (1995). Pre-emptive analgesia: a systematic review of clinical studies. Ann Med, 27, 249-56.
  224. McQuay, H.J. (1999b). Opioïds in pain management. Lancet, 353, 2229-32.
  225. McQuay, H.J., & Moore, R.A. (1998). An evidence-based resource for pain relief. Oxford: Oxford University Press, 21 (7170), 1460.
  226. McQuay, H.J., Carroll, D., & Moore, R.A. (1999a). Injected morphine in postoperative pain; a quantitative systematic review. J Pain Symptom Manage, 17, 164-74.
  227. Meylan, N., Elia, N., Lysakowski, C., & Tramer, M.R. (2009). Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials. Britisch Journal of Anaesthesia, 102 (2), 156-67.
  228. Miaskowski, C. (2009). A review of the incidence, causes, consequences, and management of GI effects associated with postoperative opioïd administration. J of PeriAnes Nursing, 24, 222-228.
  229. Milsom, I., Minic, M., Dawood, M.Y., Akin, M.D., Spann, J., Niland, N.F., & Squire, R.A. (2002). Comparison of the efficacy and safety of nonprescription doses of naproxen and naproxen sodium with ibuprofen, acetaminophen, and placebo in the treatment of primary dysmenorrhea: a pooled analysis of five studies. Clin Ther, 24, 1384-400.
  230. Miwa, Y., Yonemura, E., & Fukushima, K. (1996). Epidural administered buprenorphine in the perioperative period. Can J Anaesth, 43 (9), 907-13.
  231. Moiniche, S., Kehlet, H., & Dahl, J.B. (2002). A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology, 96, 725-41.
  232. Moiniche, S., Romsing, J., Dahl, J.B., & Tramer, M.R. (2003). Nonsteroidal antiinflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Anesth Analg, 96, 68-77.
  233. Momeni, M., Crucitti, M., & Kock, M. de (2006). Patient-controlled analgesia in the management of postoperative pain. Drugs, 66, 2321-37.
  234. Montgomery, J.E., Sutherland, C.J., Kestin, I.G., & Sneyd, J.R. (1996). Morphine consumption in patients receiving paracetamol and diclofenac alone and in combination. Br J Anaesth, 77, 445-7.
  235. Moore, A., Collins, S., Carroll, D., McQuay, H., & Edwards, J. (2000). Single dose paracetamol (acetominophen), with and without codeine, for postoperative pain (Cochrane review). In: The Cochrane Library, 2000 (2), CD001547.
  236. Moore, R.A., & McQuay, H.J. (1997). Single-patient data meta-analysis of 3543 postoperative patients: oral tramadol versus placebo, codeine and combination analgesics. Pain, 69, 287-94.
  237. Moore, R.A., & McQuay, H.J. (2006). Bandolier’s Little Book of making sense of medical evidence. Oxford: Oxford University Press.
  238. Moore, R.A., Derry, S., & McQuay, H.J. (2007). Cyclo-oxygenase-2 selective inhibitors and nonsteroidal anti-inflammatory drugs: balancing gastrointestinal and cardiovascular risk. BMC Musculoskelet Disord, 8, 73.
  239. Moore, R.A., Derry, S., & McQuay, H.J. (2009a). Single dose oral aceclofenac for postoperative pain in adults. Cochrane Database Syst Rev, 8 (3), CD007588.
  240. Moore, R.A., Derry, S., & McQuay, H.J. (2009b). Single dose oral dexibuprofen [S(+)-ibuprofen] for acute postoperative pain in adults. Cochrane Database Syst Rev, 8 (3), CD007550.
  241. Moore, R.A., Derry, S., & McQuay, H.J. (2009c). Single dose oral meloxicam for acute postoperative pain in adults. Cochrane Database Syst Rev, 7 (4), CD007552.
  242. Moore, R.A., Derry, S., McQuay, H.J., & Wiffen, P.J. (2011). Single dose oral analgesics for acute postoperative pain in adults. Cochrane Database Syst Rev, 9, CD008659.
  243. Moore, R.A., Derry, S., Moore, M., & McQuay, H.J. (2009d). Single dose oral nabumetone for acute postoperative pain in adults. Cochrane Database Syst Rev, 7 (4), CD007548.
  244. Moore, R.A., Derry, S., Moore, M., & McQuay, H.J. (2009e). Single dose oral tiaprofenic acid for acute postoperative pain in adults. Cochrane Database Syst Rev, 7 (4), CD007542.
  245. Morad, A.H., Winters, B.D., Yaster, M., Stevens, R.D., White, E.D., Thompson, R.E., ... Gottschalk, A. (2009). Efficacy of intravenous patient-controlled analgesia after supratentorial intracranial surgery: a prospective randomized controlled trial. Clinical article. J Neurosurg, 111, 343-50.
  246. Moren, J., Francois, T., Blanloeil, Y., & Pinaud, M. (1997). The effects of a NSAID (ketoprofen) on morphine respiratory depression: a double blind, randomized study in volenteers. Anesth Analg, 85, 400-5.
  247. Morlion, B., Ebner, E., Weber, A., Finke, W., & Puchstein, C. (1999). Influence of bolus size on efficacy of postoperative patient-controlled analgesia with piritramide. Br J Anaesth, 82, 52-55.
  248. Morrisson, R.S., Magaziner, J., Gilbert, M., Koval, K.J., McLaughlin, M.A., Orosz, G., ... Siu, A.L. (2003). Relationship between pain and opioïd analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci, 58, 76-81.
  249. Motamed, C., Spencer, A., Farhat, F., Bourgain, J.L., Lasser, P., & Jayr, C. (1998). Postoperative hypoxemia: continuous extradural infusion of bupivacaine and morphine vs patient controlled analgesia with intravenous morphine. Br J Anaesth, 80 (6), 742-7.
  250. Mukherjee, D., Nissen, S.E., & Topol, E.J. (2001). Risk of cardiovascular events associated with selective COX-2 inhibitors. Jama, 286, 954-9.
  251. Mulroy, M.F. (1996). Monitoring opioïds (review). Reg Anesth, 21 (6), 89-93.
  252. Munro, A.J., Long, G.T., & Sleigh, J.W. (1998). Nurse administered subcutaneous morphine is an satisfactory alternative to intravenous patient controlled analgesia morphine after cardiac surgery. Anesth Analg, 87 (1), 11-5.
  253. Nader, N.D., Li, C.M., Dosluoglu, H.H., Ignatowski, T.A., & Spengler, R.N. (2009). Adjuvant therapy with intrathecal clonidine improves postoperative pain in patients undergoing coronary artery bypass graft. Clin J Pain, 25, 101-6.
  254. National Health and Medical Research Council (NHMRC). (1999). Report. Acute pain Management: The Scientific Evidence. Camberra: NHMRC.
  255. Nesher, N., Serovian, I., Marouani, N., Chazan, S., & Weinbroum, A.A. (2008). Ketamine spares morphine consumption after transthoracic lung and heart surgery without adverse hemodynamic effects. Pharmacological Research, 58, 38-44.
  256. Nesher, N., Ekstein, M.P., Paz, Y., Marouani, N., Chazan, S., & Weinbroum, A.A. (2009). Morphine with adjuvant ketamine vs higher dose of morphine alone for immediate postthoracotomy analgesia. Chest, 136, 245-252.
  257. Neves, J.F., Monteiro, G.A., Almeida, J.R., Sant'anna, R.S., Saldanha, R.M., Moraes, J.M., ... Nóbrega, P.B. (2006). [Postoperative analgesia for cesarean section: does the addiction of clonidine to subarachnoid morphine improve the quality of the analgesia?]. Rev Bras Anestesiol, 56, 370-6.
  258. Nielsen, G.L., Sorensen, H.T., Mellemkjoer, L., Blot, W.J., McLaughlin, J.K., Tage-Jensen, U., & Olsen, J.H. (2001). Risk of hospitalization resulting from upper gastrointestinal bleeding among patients taking corticosteroids: a register-based cohort study. Am J Med, 111, 541-5.
  259. Nielsen, J.D., Holm-Nielsen, A., Jespersen, J., Vinther, C.C., Settgast, I.W., & Gram, J. (2000). The effect of low-dose acetylsalicylic acid on bleeding after transurethral prostatectomy--a prospective, randomized, double-blind, placebo-controlled study. Scand J Urol Nephrol, 34, 194-8.
  260. Nieuwenhuyzen, M.C. van den, Engbers, F.H., Burm, A.G., Vletter, A.A., Kleef, J.W. van, & Bovill, J.G. (1999). Target-controlled infusion of alfentanil for postoperative analgesia: contribution of plasma protein binding to intra-patient and inter-patient variability. Br J Anaesth, 82, 580-585.
  261. Nikanne, E., Kokki, H., Salo, J., & Linna, T.J. (2005). CeleCoxib and ketoprofen for pain management during tonsillectomy: a placebo-controlled clinical trial. Otolaryngol Head Neck Surg, 132, 287-94.
  262. Niscola, P., Scaramucci, L., Vischini, G., Giovannini, M., Ferrannini, M., Massa, P., ... Palumbo, R. (2010). The use of major analgesics in patients with renal dysfunction. Current Drug Targets, 11, 752-8.
  263. Nossaman, V.E., Ramadhyani, U., Kadowitz, P.J., & Nossaman, B.D. (2010). Advances in perioperative pain management; use of medications with dual analgesic mechanisms: tramadol and tapentadol. Anesth Clin, 28, 647-666.
  264. Nozaki-Taguchi, N., Oka, T., Kochi, T., Taguchi, N., & Mizuguchi, T. (1993). Apnoea and oximetric desaturation in patients receiving epidural morphine after gastrectomy: a comparison of intermittent bolus and patient controlled administration. Anaesth Intensive Care, 21 (3), 292-7.
  265. Nussmeier, N.A., Whelton, A.A., Brown, M.T., Langford, R.M., Hoeft, A., Parlow, J.L., ... Verburg, K.M. (2005). Complications of the COX-2 inhibitors pareCoxib and valdeCoxib after cardiac surgery. N Engl J Med, 352, 1081-91.
  266. O'Hanlon, J.J., Beers, H., Huss, B.K., & Milligan, K.R. (1996). A comparison of the effect of intramuscular diclofenac, ketorolac or piroxicam on post-operative pain following laparoscopy. Eur J Anaesthesiol, 13, 404-7.
  267. Oliveira, J.F., Silva, C.A., Barbieri, C.D., Oliveira, G.M., Zanetta, D.M., & Burdmann, E.A. (2009). Prevalence and risk factors for aminoglycoside nephrotoxicity in intensive care units. Antimicrob Agents Chemother, 53, 2887-91.
  268. Ong, C.K., Lirk, P., Seymour, R.A., & Jenkins, B.J. (2005). The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg, 100, 757-73.
  269. Ong, C.K., Lirk, P., Tan, C.H., & Seymour, R.A. (2007). An evidence-based update on nonsteroidal anti-inflammatory drugs. Clin Med Res, 5, 19-34.
  270. Ong, C.K., Seymour, R.A., Lirk, P., & Merry, A.F. (2010). Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg, 110, 1170-9.
  271. Overdyk, F.J., Carter, R., Maddox, R.R., Callura, J., Herrin, A.E., & Henriquez, C. (2007). Continuous oximetry/capnometry monitoring reveals frequent desaturation and bradypnea during patient-controlled analgesia. Anesth Analg, 105, 412-8.
  272. Ozyalzin, N.S., Yucel, A., Camlica, H., Dereli, N., Andersen, O.K., & Arendt-Nielsen, L. (2004). Effect of pre-emptive ketamine on sensory changes and postoperative pain after thoractomy: comparison of epidural and intramuscular routes. Br J Anaesth, 93, 356-61.
  273. Page, J., & Henry D. (2000). Consumption of NSAID’s and the development of congestive heart failure in elderly patients: an underrecognized public health problem. Arch Intern Med, 160, 777-84.
  274. Parc, J.M. le, Ganse, E. van, Moore, N., Wall, R., Schneid, H., & Verriere, F. (2002). Comparative tolerability of paracetamol, aspirin and ibuprofen for short-term analgesia in patients with musculoskeletal conditions: results in 4291 patients. Clin Rheumatol, 21, 28-31.
  275. Park, S.Y., Moon, S.H., Park, M.S., Oh, K.S., & Lee, H.M. (2005). The effects of ketorolac injected via patient controlled analgesia postoperatively on spinal fusion. Yonsei Med J, 46, 245-51.
  276. Peduto, V.A., Ballabio, M., & Stefanini, S. (1998). Efficacy of proparacetamol in the treatment of postoperative pain. Morphine-sparing effect in orthopedic surgery. Italian Collaborative Group on Propacetamol. Acta Anaesthesiol Scand, 42, 293-8.
  277. Pergolizzi, J., Boger, R.H., Budd, K., Dahan, A., Erdine, S., Hans, G., ... Sacerdote, P. (2008). Opioïds and the management of chronic severe pain in the elderly: consensus staement of the International Expert Panel with focus on the six clinically most often used WHO Step III opioïds (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone. Pain Pract, 8 (4), 287-313.
  278. Pergollozi, J., Aloisi, A.M., Dahan, A., Filitz, J., Langford, R., Likar, R., ... Weinbroum, A.A. (2010). Current knowledge of buprenorphine and its unique pharmacologival profile. Pain Pract, 10, 428-450.
  279. Peters, A.A.W., Witte, E.H., Damen, A.C.H., Holm, J.P., Drogendijk, A.C., Velde, E.A. van de, & Trimbos, J.B. (1996). Pain relief during and following outpatient curettage and hysterosalpingography: a double blind study to compare the efficacy and safety of tramadol versus naproxen. Eur J Obstet Gynecol Reprod Biol, 51, 51-6.
  280. Pickering, G., Loriot, M.A., Libert, F., Eschalier, A., Beaune, P., & Dubray, C. (2006). Analgesic effect of acetaminophen in humans: first evidence of a central serotonergic mechanism. Clin Pharmacol Ther, 79, 371-8.
  281. Pluijm, M.A. (1999). Tramadol suppositories are less suitable for postoperative painrelief than rectal acetominophen/codeine. Eur J Anaesth, 16 (7), 473-8.
  282. Pogatzki-Zahn, E.M., & Zahn, P.K. (2006). From preemptive to preventive analgesia. Curr Opin Anaesthesiol, 19, 551-5.
  283. Popping, D.M., Elia, N., Marret, E., Wenk, M., & Tramer, M.R. (2009). Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials. Anesthesiology, 111, 406-15.
  284. Power, I., & McCormack, J. (2007). Postoperative pain management: new, convenient analgesic therapies. Expert Opin. Pharmacotherap, 8, 391-399.
  285. Power, I., Chambers, W.A., Greer, I.A., Ramage, D., & Simon, E. (1990a). Platelet function after intramuscular diclofenac. Anaesthesia, 45, 916-9.
  286. Power, I., Noble, D.W., Douglas, E., & Spence, A.A. (1990b). Comparison of i.m. ketorolac trometamol and morphine sulphate for pain relief after cholecystectomy. Br J Anaesth, 65, 448-55.
  287. Pyati, S., & Gan, T.J. (2007). Perioperative pain management. CNS Drugs, 21 (3), 185-211.
  288. Radbruch, L., Grond, S., & Lehmann, K.A. (1996). A risk-benefit assessment of tramadol in the management of pain. [Review] Drug Safety, 15 (1), 8-29.
  289. Rahme, E., Bardou, M., Dasgupta, K., Toubouti, Y., Ghosn, J., & Barkun, A.N. (2007). Hospitalization for gastrointestinal bleeding associated with non-steroidal anti-inflammatory drugs among elderly patients using low-dose aspirin: a retrospective cohort study. Rheumatology (Oxford), 46, 265-72.
  290. Ramachandran, S.K., Haider, N., Saran, K.A., Mathis, M., Morris, M., & O’Reilly, M. (2011). Life-threathening critical respiratory events: a retrospective study of postoperative patients found unresponsive during analgesic therapy. J Clin Anesthesia, 23, 207-13.
  291. Rao, A.S., Cardosa, M., & Inbasegaran, K. (2000). Morphine sparing effect of ketoprofen after abdominal surgery. Anaesth Intensive Care, 28, 22-6.
  292. Rapanos, T., Murphy, P., Szalai, J.P., Burlacoff, L., Lam-McCulloch, J., & Kay, J. (1999). Rectal indomethacin reduces postoperative pain and morphine use after cardiac surgery. Can J Anaesth, 46, 725-30.
  293. Reeder, M.K., Goldman, M.D., Loh, L., Muir, A.D., Casey, K.R., & Lehane, J.R. (1992). Late postoperative nocturnal dips in oxygen saturation in patients undergoing major abdominal vascular surgery. Anesthesia, 47, 110-5.
  294. Remerand, F. (2009). The early and delayed analgesic effects of ketamine after total hip arthroplsty: a prospective, randomized, controlled, double-blind study. Anaesth Analg, 109, 1963-71.
  295. Remy, C., Marrett, E., & Bonnett, F. (2005). Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. Britisch Journal of Anaesthesia, 9 (94), 505-13.
  296. Rexrode, K.M., Buring, J.E., Glynn, R.J., Stampfer, M.J., Youngman, L.D., & Gaziano, J.M. (2001). Analgesic use and renal function in men. Jama, 286, 315-21.
  297. Richy, F., Bruyere, O., Ethgen, O., Rabenda, V., Bouvenot, G., Audran, M., ... Reginster, J.Y. (2004). Time dependent risk of gastrointestinal complications induced by non-steroidal anti-inflammatory drug use: a consensus statement using a meta-analytic approach. Ann Rheum Dis, 63, 759-66.
  298. Riley, J. (2008).Oxycodone: a review of its use in the management of pain. Curr Med Research and Opinions, 24, 175-192.
  299. Rittner, H.L., Roewer, N., & Brack, A. (2010). The clinical (ir)relevance of opioïd-induced immune suppression. Curr Opin Anaesthesiol, 23, 588-592.
  300. Romsing, J., & Moiniche, S. (2004). A systematic review of COX-2 inhibitors compared with traditional NSAID’s, or different COX-2 inhibitors for post-operative pain. Acta Anaesthesiol Scand, 48, 525-46.
  301. Romsing, J., Moiniche, S., Mathiesen, O., & Dahl, J.B. (2005). Reduction of opioïd-related adverse effects using opioïd-sparing analgesia with COCX2 inhibitors lacks documentation: a systematic review. Acta Anaesthesiol Scand, 49, 133-142.
  302. Rosenberg, J., & Kehlet, H. (1993). Postoperative mental confusion, association with postoperative hypoxemia. Surgery, 114 (1), 76-81.
  303. Rosenberg, P.H., Heino, A., & Scheinin, B. (1984). Comparison of intramuscular analgesia, intercostal block, epidural morphine and on-demand-i.v.-fentanyl in the control of pain after upper abdominal surgery. Acta Anaesthesiol Scand, 28, 603-7.
  304. Rostom, A., Muir, K., Dube, C., Jolicoeur, E., Boucher, M., Joyce, J., ... Wells, G.W. (2007). Gastrointestinal safety of cyclooxygenase-2 inhibitors: a Cochrane Collaboration systematic review. Clin Gastroenterol Hepatol, 5, 818-28.
  305. Rothwell, M.O., Pearson, D., Hunter, J.D., Mitchell, P.A., Graham-Woollard, Goodwin, L., & Dunn, G. (2011). Oral oxycodone offers equivalent analgesia to intravenous patient-controlled analgesia after total hip replacement: a randomized, single-centre, non-blinded, non-inferiority study. Br J Anesthesia, 106 (6), 865-72.
  306. Rubenstein, J.H., & Laine, L. (2004). Systematic review: the hepatotoxicity of non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther, 20, 373-80.
  307. Sadusk, J.F. (1965). The Relationship of the Food and Drug Administration to the Practice of Medicine and the Aminopyrine-Dipyrone Problem. J New Drugs, 28, 57-62.
  308. Sarton, E., Olofsen, E., Romberg, R., Hartigh, J. den, Kest, B., Nieuwenhuijs, D., ... Dahan, A. (2000). Sex differences in morphine analgesia: an experimental study in healthy volunteers. Anesthesiology, 93, 1245-54.
  309. Scheiman, J.M., Yeomans, N.D., Talley, N.J., Vakil, N., Chan, F.K., Tulassay, Z., ... Hawkey, C. (2006). Prevention of ulcers by esomeprazole in at-risk patients using non-selective NSAID’s and COX-2 inhibitors. Am J Gastroenterol, 101, 701-10.
  310. Schnitzer, T.J., Burmester, G.R., Mysler, E., Hochberg, M.C., Doherty, M., Ehrsam, E., ... Hawkey, C.J. (2004). Comparison of lumiraCoxib with naproxen and ibuprofen in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), reduction in ulcer complications: randomised controlled trial. Lancet, 364, 665-74.
  311. Schug, S.A., Sidebotham, D.A., McGuinnety, M., Thomas, J., & Fox, L. (1998). Acetominophen as an adjunct to morphine by patient controlled analgesia in the management of acute postoperative pain. Anesth. Analg., 87 (2), 368-72.
  312. Scott, L.J., & Perry, C.M. (2000). Tramadol: a review of its use in perioperative pain. Drugs, 60 (1), 139-76.
  313. Scott, P.A., Kingsley, G.H., & Scott, D.L. (2008). Non-steroidal anti-inflammatory drugs and cardiac failure: meta-analyses of observational studies and randomised controlled trials. Eur J Heart Fail, 10, 1102-7.
  314. Sear, J.W., Hand, C.W., Moore, R.A., & McQuay, H.J. (1989). Studies on morphine disposition: influence of renal failure on kinetics of morphine and metabolites. Br J Anesth, 62, 28-32.
  315. Sevarino, F.B., (1997). Postoperative analgesia with parenteral opioïds: does continuous delivery utilizing a transdermal opioïd preparation affect analgesic efficacy or patient safety? J Clin Anesth, 9, 173-8.
  316. Shapiro, S., Issaragrisil, S., Kaufman, D.W., Anderson, T., Chansung, K., Thamprasit, T., ... Young, N.S. (1999). Agranulocytosis in Bangkok, Thailand: a predominantly drug-induced disease with an unusually low incidence. Aplastic Anemia Study Group. Am J Trop Med Hyg, 60, 573-7.
  317. Silvasti, M., Rosenberg, P., Seppala, T., Svartling, N., & Pitkanen, M. (1998). Comparison of analgesic efficacy of oxycodone and morphine in postoperative intravenous patient-controlled analgesia. Acta Anaesthesiol Scand, 42, 576-80.
  318. Silverstein, F.E., Faich, G., Goldstein, J.L., Simon, L.S., Pincus, T., Whelton, A., ... Geis, G.S. (2000). Gastrointestinal toxicity with celeCoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: A randomized controlled trial. CeleCoxib Long-term Arthritis Safety Study. Jama, 284, 1247-55.
  319. Silverstein, F.E., Graham, D.Y., Senior, J.R., Davies, H.W., Struthers, B.J., Bittman, R.M., & Geis, G.S. (1995). Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs. A randomized, double-blind, placebo-controlled trial. Ann Intern Med, 123, 241-9.
  320. Sinatra, R.S., Torres, J., & Bustos, A.M. (2002). Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg, 10, 117-129.
  321. Sinatra, R.S., Jahr, J.S., Reynolds, L.W., Viscusi, E.R., Groudine, S.B., & Payen-Champenois, C. (2005). Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology, 102, 822-31.
  322. Singh, G., Fort, J.G., Goldstein, J.L., Levy, R.A., Hanrahan, P.S., Bello, A.E., ... Triadafilopoulos, G. (2006). CeleCoxib versus naproxen and diclofenac in osteoarthritis patients: SUCCESS-I Study. Am J Med, 119, 255-66.
  323. Sites, B.D., Beach, M., Biggs, R., Rohan, C., Wiley, C., Rassias, A., ... Fanciullo, G. (2003). Intrathecal clonidine added to a bupivacaine-morphine spinal anesthetic improves postoperative analgesia for total knee arthroplasty. Anesth Analg, 96, 1083-8.
  324. Slappendel, R., Weber, E.W., Benraad, B., Limbeek, J. van, & Dirksen, R. (2000). Itching after intrathecal morphine. Incidence and treatment. Eur J Aneasthesiol, 17 (10), 616-21.
  325. Slappendel, R., Weber, E.W., Dirksen, R., Gielen, M.J., & Limbeek, J. van (1999). Optimization of the dose of intrathecal morphine in total hip surgery: a dose finding study. Anesth Analg, 88, 822-6.
  326. Smith, G., & Power, I. (1998). Audit and bridging the analgesic gap. Anesthesia, 53, 521-2.
  327. Smith, H., & Bruckenthal, P. (2010). Implications of opioïd analgesia for medically complicated patients. Drugs aging, 27 (5), 417-433.
  328. Smith, L.A., Carroll, D., Edwards, J.E., Moore, R.A., & McQuay, H.J. (2000). Single dose ketorolac and pethidine in acute postoperative pain: systematic review with meta-analysis. Br J Anaesth, 84 (1), 48-58.
  329. Snijdelaar, D.G., Cornelisse, H.B., Schmid, R.L., & Katz, J. (2004). A randomised, controlled study of perioperative low dose S(+)-ketamine in combination with postoperative patient-controlled S(+)-ketamine and morphine after radical prostatectomy. Anaesthesia, 59, 222-228.
  330. Solomon, S.D., McMurray, J.J., Pfeffer, M.A., Wittes, J., Fowler, R., Finn, P., ... Bertagnolli, M. (2005). Cardiovascular risk associated with celeCoxib in a clinical trial for colorectal adenoma prevention. N Engl J Med, 352, 1071-80.
  331. Spiegel, B.M., Farid, M., Dulai, G.S., Gralnek, I.M., & Kanwal, F. (2006). Comparing rates of dyspepsia with Coxibs vs NSAID+PPI: a meta-analysis. Am J Med, 119, 448.
  332. Stamer, U.M., Grond, S., & Maier, C. (1999). Responders and non-responders to postoperative pain treatment: the loading dose predicts analgesic needs. Eur J Anaesthesiol, 16, 103-10.
  333. Strand, V. (2007). Are COX-2 inhibitors preferable to non-selective non-steroidal anti-inflammatory drugs in patients with risk of cardiovascular events taking low-dose aspirin? Lancet, 370, 2138-51.
  334. Straube, S., Derry, S., Moore, R.A., Wiffen, P.J., & McQuay, H.J. (2010). Single dose oral gabapentin for established acute postoperative pain in adults. Cochrane Database Syst Rev, 12 (5), CD008183.
  335. Subramaniam, K., Subramaniam, B., & Steinbrook, R.A. (2004). Ketamine as adjuvant analgesic to opioïds: a quantitative and qualitative systematic review. Anesth. Analg., 99, 482-95 A1
  336. Sudano, I., Flammer, A.J., Periat, D., Enseleit, F., Hermann, M., Wolfrum, M., ... Ruschitzka, F. (2010). Acetaminophen increases blood pressure in patients with coronary artery disease. Circulation, 122, 1789-96.
  337. Sultan, A., McQuay, H.J., Moore, R.A, & Derry, S. (2009). Single dose oral flurbiprofen for acute postoperative pain in adults. Cochrane Database Syst Rev,8 (3), CD007358.
  338. Taylor, S., Kirton, O.C., Staff, I., & Kozol, R.A. (2005). Postoperative day one: a high risk period for respiratory events. Am J of Surg, 190, 752-756.
  339. Thoren, T., Sundberg, A., Wattwil, M., Garvill, J.E., & Jurgensen, U. (1989). Effects of epidural bupivacaine and epidural mrphine on bowel function and pain after hysterectomy. Acta Anaesthesiol Scand, 33, 181-5.
  340. Thorn, S.E., Wattwil, M., Lindberg, G., & Sawe, J. (1996). Systemic and central effects of morphine on gastroduodenal motility. Acta Anaesthesiol Scand, 40 (2), 177-86.
  341. Toenders, W.G.M., Koopmans, R.P., & Kraan, M.C. (2001). Cox-2-selectieve NSAID’s: even effectief, maar minder bijwerkingen? Geneesm Bull, 35 (3), 25-31.
  342. Toms, L., Derry, S., Moore, R.A., & McQuay, H.J. (2009). Single dose oral paracetamol (acetaminophen) with codeine for postoperative pain in adults. Cochrane Database Syst Rev, 21 (1), CD001547.
  343. Toms, L., McQuay, H.J., Derry, S., & Moore, R.A. (2008). Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. Cochrane Database Syst Rev, 8 (4), CD004602.
  344. Tramer, M.R., Williams, J.E., Carroll, D., Wiffen, P.J., Moore, R.A., & McQuay, H.J. (1998). Comparing analgesic efficacy of non-steroidal anti-inflammatory drugs given by different routes in acute and chronic pain: a qualitative systematic review. Acta Anaesthesiol Scand, 42, 71-9.
  345. Tucker, A.P., Kim, Y.I., Nadeson, R., & Goodchild, C.S. (2005). Investigation of the potentiation of the analgesic effects of fentanyl by ketamine in humans: a double-blinded, randomised, placebo-controlled, crossover study of experimental pain. BMC Anesthesiol., 5, 2.
  346. Tveita, T., Thoner, J., Klepstad, P., Dale, O., Jystad, A., & Borchgrevink, P.C. (2008). A Controlled comparison between single doses of intravenous and intramuscular morphine with respect to analgesic effects and patient safety. Acta Anaesthesiol Scand, 52, 920-925.
  347. Tyler, D.C., Pomietto, M., & Womack, W. (1996). Variation in opioïd use during PCA in adolescents. Paediatr Anaesth, 6, 33-8 .
  348. Tyndale, R.F., Droll, K.P., & Sellers, E.M. (1997). Genetically deficient CYP2D6 metabolism provides protection against oral opiate dependence. Pharmacogenetics, 7, 375-9.
  349. Unlugenc, H., Ozalevli, M., Guler, T., & Isik, G. (2003). Postoperative pain management with intravenous patient-controlled morphine: comparison of the effect of adding magnesium or ketamine. Eur J Anaesthesiol, 20, 416-21.
  350. Unlugenc, H., Vardar, M.A., & Tetiker, S. (2008). A comparative study of the analgesic effect of patient-controlled morphine, pethidine, and tramadol for postoperative pain management after abdominal hysterectomy. Anesth Analg, 106 (10), 309-12.
  351. Upton, R.N., Semple, T.J., & McIntyre, P.E. (1997). Pharmacokinetic optimisation of opioïd treatment in acute pain therapy. Clin Pharmacokin, 33, 225-44.
  352. Vadivelu, N. & Anwar, M. (2010). Buprenorphine in postoperative pain management. Anesthesiology Clin, 28, 601-609.
  353. Vedula, S.S., Bero, L., Scherer, R.W., & Dickersin, K. (2009). Outcome reporting in industry-sponsored trials of gabapentin for off-label use. N Engl J Med., 361 (20), 1963-71.
  354. Viscusi, E.R., Reynolds, L., Chung, F., Atkinson, L.E., & Khanna, S. (2004). Patient-controlled transdermal fentanyl hydrochloride vs intravenous morphine pump for postoperative pain. JAMA, 291, 1338-1341.
  355. Walder, B., Schafer, M., Henzi, I., & Tramer, M.R. (2001). Efficacy and safety of patient-controlled opioïd analgesia for acute postoperative pain. A quantitative systematic review. Acta Anaesthesiol Scand, 45, 795-804.
  356. Watkins, P.B., Kaplowitz, N., Slattery, J.T., Colonese, C.R., Colucci, S.V., Stewart, P.W., & Harris, S.C. (2006). Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily: a randomized controlled trial. Jama, 296, 87-93.
  357. Weber, E.W., Slappendel, R., Durieux, M.E., Dirksen, R., Heide, H. van der, & Spruit, M. (2003). COX 2 selectivity of non-steroidal anti-inflammatory drugs and perioperative blood loss in hip surgery. A randomized comparison of indomethacin and meloxicam. Eur J Anaesthesiol, 20, 963-6.
  358. Weber, L.M., Ghafoor, V.L., & Phelps, P. (2008). Implementation of standard order sets for patient-controlled analgesia. Am J Health Syst Pharm, 65, 1184-91.
  359. Weinbroum, A.A. (2003). A single small dose of postoperative ketamine provides rapid and sustained improvement in morphine analgesia in the presence of morphine-resistant pain. Anaesth analg, 96, 789-95.B
  360. Weir, M.R. (2002). Renal effects of nonselective NSAID’s and Coxibs. Cleve Clin J Med, 69 (1), SI53-8.
  361. Welchew, E.A. (1983). On-demand analgesia. A double-blind comparison of on-demand intravenous fentanyl with regular intramuscular morphine. Anaesthesia, ,38, 19-25.
  362. Werawatganon, T., & Charuluxananan, S. (2005). Patient controlled intravenous opioïd analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database of Systematic reviews, 1, CD004088.
  363. West, P.M., & Fernandez, C. (2003). Safety of COX-2 inhibitors in asthma patients with aspirin hypersensitivity. Ann Pharmacother, 37, 1497-501.
  364. Wheatley, R.G., Shepherd, D., Jackson, I.J., Madej, T.H., & Hunter, D. (1992). Hypoxemia and pain relief after upper abdominal surgery: comparison of i.m. and patient controlled analgesia. Br J Anaesth 1992, 69 (6), 558-61.
  365. Wheatley, R.G., Somerville, I.D., Sapsford, D.J., & Jones, J.G. (1990). Postoperative hypoxemia: comparison of extradural, i.m. and patient controlled opioïd analgesia. Br.J. Anaesth., 64 (3), 267-75.
  366. White, P.F. (1987). Mishaps with patient-controlled analgesia. Anesthesiology, 66, 81-3.
  367. White, P.F. (1990). Subcutaneous-PCA: an alternative to IV-PCA for postoperative pain management. Clin J Pain, 6 (4), 297-300.
  368. Wideman, G.L., Keffer, M., Morris, E., Doyle, R.T. Jr, Jiang, J.G., & Beaver, W.T. (1999). Analgesic efficacy of a combination of hydrocodone with ibuprofen in postoperative pain. Clin Pharmacol Ther, 65, 66-76.
  369. Wideman, G.L., Keffer, M., Morris, E., Doyle, R.T., Jiang, J.G., & Beaver, W.T. (1997). Ketorolac potentiates morphine in postoperative patient-controlled analgesia. Pain, 73, 401-6.
  370. Wilder-Smith, O.H., & Rendt-Nielsen, L. (2006). Postoperative hyperalgesia: its clinical importance and relevance. Anesthesiology, 104, 601-7
  371. Wininger, S.J., Miller, H., Minkowitz, H.S., Royal, M.A., Ang, R.Y., Breitmeyer, J.B., & Singla, N.K. (2010). A randomized, double-blind, placebo-controlled, multicenter, repeat-dose study of two intravenous acetaminophen dosing regimens for the treatment of pain after abdominal laparoscopic surgery. Clin Ther, 32, 2348-69.
  372. Witjes, ... (1992). Application of sublingual buprenorphine in combination with naproxen or paracetamol for post-operative pain relief in cholecystectomy paients in a double-blind study. Acta Anaesthesiol Scand, 36 (4), 323-7.
  373. Wolfe, M.M., Lichtenstein, D.R., & Singh, G. (1999). Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med, 340, 1888-99.
  374. Wong, J.O., Tan, T.D., Cheu, N.W., Wang, Y.R., Liao, C.H., Chuang, F.H., & Watts, M.P. (2010). Comparison of the efficacy of pareCoxib versus ketorolac combined with morphine on patient-controlled analgesia for post-cesarean delivery pain management. Acta Anaesthesiol Taiwan, 48, 174-7.
  375. Woodhouse, A., & Mather, L.E. (2000). The minimum effective concentration of opioïds: a revisitation with patient-controlled analgesia fentanyl. Reg Anesth Pain Med, 25, 259-67.
  376. Woodhouse, A., Ward, M.E., & Mather, L.E. (1999). Intra-subject variability in postoperative patient controlled analgesia (PCA): is the patient equally satisfied with morphine, pethidine and fentanyl? Pain, 80 (3), 545-53.
  377. Wrona, S., Chisolm, D.J., Powers, M., & Miler, V. (2007). Improving processes of care in patient-controlled analgesia: the impact of computerized order sets and acute pain service patient management. Paediatr Anaesth, 17, 1083-9.
  378. Xuerong, Y. Yuguang, H., Xia, J., & Hailan, W. (2008). Ketamine and lornoxicam for preventing a fentanyl-induced increase in postoperative morphine requirement. Anaesth Analg 2008;107:2032-7. A2Zakine J. et al. Postoperative ketamine administration decreases morphine consumption in major abdominal surgery: a prospective, randomized, double-blind, controlled study. Anaesth Analg, 106, 1856-61.
  379. Yeomans, N.D., Tulassay, Z., Juhasz, L., Rácz, I., Howard, J.M., Rensburg, C.J. van, ... Hawkey, C.J. (1998). A comparison of omeprazole with ranitidine for ulcers associated with nonsteroidal antiinflammatory drugs. Acid Suppression Trial: Ranitidine versus Omeprazole for NSAID-associated Ulcer Treatment (ASTRONAUT) Study Group. N Engl J Med, 338, 719-26.
  380. Zacny, J.P., Conley, K., & Galinkin, J. (1997). Comparing the subjective, psychomotor and physiological effects of intravenous buprenorphine and morphine in healthy volunteers. J Pharmacol Exp Ther, 282 (3), 1187-97.
  381. Zemmel, M.H. (2006). The role of COX-2 inhibitors in the perioperative setting: efficacy and safety--a systematic review. Aana J, 74, 49-60.
  382. Zeppetella, G. (2011). Opioïds for the management of breakthrough cancer pain in adults: a systematic review undertaken as part of an EPCRC opioïd guidelines project. Palliat Med, 25 (5), 516-24.
  383. Zeppetella, G., & Ribeiro, M.D. (2006). Opioïds for the management of breakthrough (episodic) pain in cancer patients. Cochrane Database Syst Rev, 25 (1), CD004311.
  384. Zhang, J., Ho, K.Y., & Wang, Y. (2011). Efficacy of pregabalin in acute postoperative pain: a meta-analysis. Br J Anaesth., 106 (4), 454-62.
  385. Zhou, H.H., Sheller, J.R., Nu, H., Wood, M., & Wood, A.J. (1993). Ethnic differences in response to morphine. Clin Pharmacol Ther, 54, 507-13.

Autorisatiedatum en geldigheid

Laatst beoordeeld : 01-07-2013

Laatst geautoriseerd : 01-07-2013

Uiterlijk in 2018 bepaalt het bestuur van de NVA of deze richtlijn nog actueel is. Zo nodig wordt een nieuwe werkgroep geïnstalleerd om de richtlijn te herzien. De geldigheid van de richtlijn komt eerder te vervallen indien nieuwe ontwikkelingen aanleiding zijn een herzieningstraject te starten.

 

De NVA is als houder van deze richtlijn de eerstverantwoordelijke voor de actualiteit van deze richtlijn. De andere aan deze richtlijn deelnemende wetenschappelijk verenigingen of gebruikers van de richtlijn delen de verantwoordelijkheid en informeren de eerstverantwoordelijke over relevante ontwikkelingen binnen hun vakgebied.

Initiatief en autorisatie

Initiatief:
  • Nederlandse Vereniging voor Anesthesiologie
Geautoriseerd door:
  • Nederlandse Orthopaedische Vereniging
  • Nederlandse Vereniging voor Heelkunde
  • Nederlandse Vereniging voor Kindergeneeskunde
  • Nederlandse Vereniging voor Thoraxchirurgie

Algemene gegevens

Met ondersteuning van de Orde van Medisch Specialisten. De richtlijnontwikkeling werd gefinancierd uit de Kwaliteitsgelden Medisch Specialisten (SKMS).

Doel en doelgroep

De huidige richtlijn moet de accuratesse van de volgende punten weergeven:

  • ­de organisatie van de postoperatieve pijnbehandeling. Wie is op welk moment van de pijnbehandeling verantwoordelijk?
  • ­wat is het effect van nieuwe pijnmedicatie en hoe staat dat in verhouding tot de reeds bestaande medicatie?
  • ­welke toedieningsvormen zijn optimaal?
  • ­kosteneffectiviteit van postoperatieve pijnbestrijding;
  • ­postoperatieve pijnbehandeling bij kinderen.

 

Deze richtlijn is geschreven voor alle leden van de beroepsgroepen die betrokken zijn bij postoperatieve pijnbehandeling.

Samenstelling werkgroep

Voor het herzien van de richtlijn is in 2010 een multidisciplinaire werkgroep ingesteld, bestaande uit vertegenwoordigers van alle relevante specialismen die met postoperatieve pijnbehandeling te maken hebben (zie hiervoor de samenstelling van de werkgroep).

De werkgroepleden werden door hun beroepsverenigingen gemandateerd voor deelname. De werkgroep werkte gedurende twee jaar aan de totstandkoming van de richtlijn.

 

  • ­Dr. P.L. Houweling, voorzitter, anesthesioloog, NVA
  • ­Dhr. P.M. Ruikes, verpleegkundig specialist, (NVAM)
  • ­Dr. M.I. van Berge Henegouwen, chirurg (NVvH)
  • ­Dr. S.J.C. Verbrugge, anesthesioloog/intensivist, (NVIC)
  • ­Drs. A. Tjon, cardiothoracale chirurg, (NVT)
  • ­Drs. D.B.M. van der Werff, kinderanesthesioloog, WKZ/UMCU
  • ­Drs. I.M.M. van Haelst, ziekenhuisapotheker, (NVZA)
  • ­Drs. H. Verburg, orthopedisch chirurg, (NOV)
  • ­Mw. R. van Boekel, verpleegkundig pijnconsulent (V&VN Pijnverpleegkundigen)
  • ­Prof. dr. D. Tibboel, kinderarts, (NVK)
  • ­Prof. dr. dr. M.W. Hollmann, anesthesioloog (NvA)

 

Met ondersteuning van:

  • ­Ir. T.A. van Barneveld, senior adviseur, afdeling Ondersteuning Professionele Kwaliteit, Orde van Medisch Specialisten
  • ­Dr. M.L. Molag, adviseur, afdeling Ondersteuning Professionele Kwaliteit, Orde van Medisch Specialisten

 

Met dank aan:

  • ­Dr. M.F. Stevens, anesthesioloog (NVA)
  • ­Dr. J.H. Vranken, anesthesioloog (NVA)

Belangenverklaringen

Werkgroepleden hebben schriftelijk verklaard of ze in de laatste vijf jaar een (financieel ondersteunde) betrekking onderhielden met commerciële bedrijven, organisaties of instellingen die in verband staan met het onderwerp van de richtlijn. Een overzicht hiervan is hieronder te vinden. De belangenverklaringen zijn op te vragen bij het secretariaat van OMS.

 

Verklaring omtrent mogelijke belangenverstrengeling en embargo met betrekking tot de richtlijn ‘Postoperatieve pijn'

 

Werkgroeplid in de laatste vijf jaar een (financieel ondersteunde) betrekking onderhield met commerciële bedrijven, organisaties of instellingen die in verband staan met het onderwerp

Werkgroeplid

Belangen afgelopen vijf jaar en/of gedurende looptijd van het project ja /nee

Zo ja, welke

Berge Henegouwen, dr. M.I. van

Nee

 

Boekel, mw. R. van

Ja

Gastdocent bij HAN-vdo: cursus 'Assistent Pijnbehandeling'

Haelst, mw. Drs. I.M.M. van

Nee

 

Hollmann, M.W.

Ja

Eurocept - lecturer over Peri-op pijnbestrijding

Houweling, dr. P.

Nee

 

Ruikes, P.M.

Nee

 

Tibboel, prof. dr. D.

Nee

 

Tjon Joek Tjien, A

Nee

 

Verburg, H.

Nee

 

Verbrugge, dr. S.J.C.

Nee

 

Werff, D.B.M. van der

Nee

 

Inbreng patiëntenperspectief

De inbreng van patiënten werd meegenomen door te kijken naar de uitkomstmaat ‘pijn’. Daarnaast werd een oriënterende literatuursearch uitgevoerd gericht op het patiëntenperspectief. Dit leverde drie mogelijk interessante artikelen op, waarvan uiteindelijk één werd gebruikt in de tekst organisatie van zorg.

Methode ontwikkeling

Evidence based

Implementatie

In de verschillende fasen van de richtlijnontwikkeling is rekening gehouden met de implementatie van de richtlijn en de praktische uitvoerbaarheid van de aanbevelingen. Daarbij is uitdrukkelijk gelet op factoren die de invoering van de richtlijn in de praktijk kunnen bevorderen of belemmeren.

 

De richtlijn is/wordt verspreid onder alle relevante beroepsgroepen en ziekenhuizen. Daarnaast is/wordt er een samenvatting van de richtlijn geschreven voor het Nederlands Tijdschrift voor Geneeskunde en in tijdschriften van de deelnemende wetenschappelijke verenigingen.

Werkwijze

AGREE

Deze richtlijn is opgesteld aan de hand van het “Appraisal of Guidelines for Research & Evaluation II” (AGREE II) instrument. Dit is een internationaal breed geaccepteerd instrument voor de beoordeling van de kwaliteit van richtlijnen.

 

Vaststellen van de uitkomstmaten en klinische relevantie

In de voorbereidende fase van de richtlijnontwikkeling zijn de uitkomstmaten geïnventariseerd en geordend naar mate van belangrijkheid voor de patiënt. Voor het evalueren van invasieve behandelmogelijkheden achtte de werkgroep de uitkomstmaten pijn, functionaliteit en kwaliteit van leven van belang. Op basis van een artikel van Ostelo et al. (2008) werd het klinisch relevante verschil voor pijn en functionaliteit vastgesteld (zie tabel 1.).

 

Tabel 1. Drempelwaardes klinisch relevant verschil pijn en functionaliteit bij lage rugpijn

Vragenlijst* (range)

Absolute drempel

Relatieve drempel t.o.v. uitgangswaarde

VAS (0-100)

15

30%

NRS (0-10)

2

30%

RDQ (0-24)

5

30%

ODI (0-100)

10

30%

QBPQ (0-100)

20

30%

*VAS = visual analogue scale, NRS = numerical rating scale, RDQ = Roland Morris Disability Questionnaire, ODI = Oswestry Disability Index, QBDQ = Quebec Back Pain Disability Questionnaire

 

Strategie voor zoeken en selecteren van literatuur

Er werd eerst oriënterend gezocht naar klinisch relevante verschillen bij rugpijn bij uitkomsten als pijn (gemeten met Visual Analogue Scale, VAS of numerical rating scale, NRS), kwaliteit van leven (gemeten met EQ-5D) en functionaliteit (gemeten met Roland Morris Disability Questionnaire, Oswestry Disability Index of Quebec Back Pain Disability Questionnaire). Vervolgens werd er voor de afzonderlijke uitgangsvragen aan de hand van specifieke zoektermen gezocht naar gepubliceerde wetenschappelijke studies in het Engels en Nederlands in de elektronische databases Medline (OVID) en Embase (Embase.com) over de periode 1990- juni 2011. De zoekstrategieën zijn te vinden in bijlage 1. Tevens werd er aanvullend handmatig gezocht naar studies in de referentielijsten van de geïncludeerde artikelen. In eerste instantie werd gezocht naar (systematische reviews of meta-analyses van) gerandomiseerde gecontroleerde onderzoeken (RCTs). In afwezigheid van RCTs werd verder gezocht naar prospectieve gecontroleerde onderzoeken, vergelijkende onderzoeken en prospectieve niet-vergelijkende onderzoeken. Voor het identificeren van  mogelijke systematische reviews en randomized controlled trials werd gebruik gemaakt van methodologische zoekfilters gebaseerd op die van het Scottish Intercollegiate Guidelines Network.

De sluitingsdatum voor het includeren van studies is juni 2011, de studies van na juni 2011 zijn niet meegenomen in deze richtlijn.

 

Rapportage

Omdat de diagnoses niet algemeen geaccepteerd zijn, is er voor gekozen per diagnose een evidence-based beschrijving te geven van de definitie, de epidemiologie, de etiologie, de diagnostiek en de interventies.

 

Beoordelen van therapeutische interventiestudies

Beoordeling van studies werd gedaan aan de hand van de GRADE methodiek (http://www.gradeworkinggroup.org/). Per uitkomstmaat werd het niveau van de bewijslast bepaald op basis van alle beoordeelde studies samen. Naar aanleiding van deze beoordeling werd het bewijsniveau bepaald volgens de classificatie in tabel 2. GRADE kent vier bewijsniveaus: hoog, matig, laag en zeer laag. Het onderzoeksdesign bepaalt het startniveau van de bewijskracht: systematische literatuuranalyses van RCTs starten hoog en systematische literatuuranalyses van observationele onderzoeken starten laag. Er zijn vijf factoren (beperkingen in de onderzoeksopzet, inconsistentie, indirectheid, imprecisie, publicatiebias) die de bewijskracht met één of twee niveaus kunnen verlagen. De werkgroep bepaalde hoe belangrijk deze factoren waren.

Daarnaast zijn er drie factoren die de bewijslast van een systematische literatuuranalyse van observationeel onderzoek kunnen verhogen (groot effect, dosisrespons relatie, confounding die het werkelijke effect onderschat of een in werkelijkheid niet bestaand effect overschat).

 

Tabel 2. GRADE-indeling van kwaliteit van studies per uitkomstmaat

Kwaliteit

Studiedesign

Kwaliteit verlagen

Kwaliteit verhogen

Hoog (4)

RCT

1. Studiebeperkingen

-1  ernstig

-2  zeer ernstig

 

2. Inconsistentie

-1  ernstig

-2  zeer ernstig

 

3. Indirectheid

-1  ernstig

-2  zeer ernstig

 

4. Imprecisie

-1  ernstig

-2  zeer ernstig

 

5. Publicatiebias

-1  waarschijnlijk

-2  zeer waarschijnlijk

1. Groot effect

+1  groot

+2  zeer groot

 

2. Dosis-respons relatie

+1  bewijs voor relatie

 

3. Plausibele confounding

+1  zou het effect onderschatten

+1  zou het effect overschatten als er geen effect was aangetoond

 

Matig (3)

 

Laag (2)

Observationele vergelijkende studie (vb. patientcontrole onderzoek, cohortonderzoek)

Zeer laag (1)

Niet-systematische klinische observaties (vb. case series of case reports)

 

 

RCTs beginnen ‘hoog’ (4), observationele studies beginnen ‘laag’ (2)

Bij RCTs: vb. totaal 1 punt downgraden: dan van hoog (4) naar matig (3); bij RCTs: vb. totaal 2 punten downgraden: dan van hoog (4) naar laag (2); bij RCTs: in totaal ≥ 3 punten downgraden: dan van hoog (4) naar zeer laag (1)

Bij observationele studies: vb. 1 punt upgraden: dan van laag (2) naar matig (3)

 

Een samenvatting van de literatuur en het bewijsniveau van de relevante studies zijn in de richtlijntekst terug te vinden onder de kopjes ‘samenvatting van de literatuur’ en ‘conclusie’.

 

Beoordelen van diagnostisch accuratesse onderzoek en studies naar schade of bijwerkingen, etiologie en prognose

Beoordeling van dit soort onderzoeken werd gedaan aan de hand van de EBRO methodiek (GRADE is hier momenteel nog niet geschikt voor, omdat voor deze studies de relatie tussen de kwaliteit van het onderzoek en de vertekening van het resultaat nog onvoldoende duidelijk is). De studies werden individueel beoordeeld op onderzoeksopzet/design. Naar aanleiding van deze beoordeling werd het bewijsniveau van studies bepaald volgens de classificatie in tabel 3.

 

Tabel 3. EBRO indeling van de kwaliteit van individuele studies

Bewijs niveau

Diagnostisch accuratesse onderzoek

Schade of bijwerkingen, etiologie, prognose

A1

Meta-analyse van min. 2 onafhankelijk van elkaar uitgevoerde onderzoeken van A2-niveau

A2

Onderzoek t.o.v. een referentietest (‘gouden standaard’) met tevoren gedefinieerde afkapwaarden en onafhankelijke beoordeling van resultaten, met voldoende grote serie van opeenvolgende patiënten die allen de index- en referentietest hebben gehad

Prospectief cohort onderzoek van voldoende omvang en follow-up, waarbij adequaat gecontroleerd is voor ‘confounding’ en selectieve follow-up voldoende is uitgesloten.

B

Onderzoek t.o.v. een referentietest, maar niet met alle kenmerken die onder A2 zijn genoemd

Prospectief cohort onderzoek, maar niet met alle kenmerken als genoemd onder A2 of retrospectief cohort onderzoek of patiëntcontrole onderzoek

C

Niet-vergelijkend onderzoek

 

Een samenvatting van de literatuur en het bewijsniveau van de relevante studies zijn in de richtlijntekst terug te vinden onder de kopjes ‘samenvatting van de literatuur’ en ‘conclusie’. Individuele studies waarop conclusies gebaseerd zijn, zijn samengevat in evidencetabellen (zie kopje Evidencetabellen).

 

Werkwijze werkgroep

De keuze van de onderwerpen en de interventies is gebaseerd op datgene wat te doen gebruikelijk is in de verschillende beroepsgroepen. De richtlijn probeert antwoord te geven op klinisch relevante problematiek.

De richtlijn beperkt zich tot interventionele therapieën. In een latere richtlijn moet de conservatieve behandeling meegenomen worden.

De werkgroep heeft anderhalf jaar aan de totstandkoming van de richtlijn gewerkt. De werkgroepleden hebben de knelpunten en uitgangsvragen vastgesteld. Met behulp van de informatiespecialist van de Orde van Medisch Specialisten is literatuur gezocht bij de uitgangsvragen. De leden van de werkgroep hebben samen met de adviseur van de Orde de gevonden literatuur geselecteerd en beoordeeld op kwaliteit en inhoud. De werkgroepleden hebben conceptteksten voor de uitgangsvragen geschreven. De conceptrichtlijn is in september 2011 aan alle betrokken wetenschappelijke verenigingen aangeboden. De ontvangen commentaren zijn, waar relevant bevonden, verwerkt in de definitieve richtlijn.

 

Overwegingen

Voor een aanbeveling zijn er naast het wetenschappelijke bewijs nog andere aspecten van belang, zoals de expertise van de werkgroepleden, patiëntenvoorkeuren, kosten, beschikbaarheid van voorzieningen of organisatorische facetten. Deze aspecten worden, voor zover niet wetenschappelijk onderzocht, vermeld onder het kopje ‘overwegingen’.

               

Formuleren van aanbevelingen

De aanbevelingen geven een antwoord op de uitgangsvraag en zijn gebaseerd op zowel het beschikbare wetenschappelijke bewijs als op de belangrijkste overwegingen.

In de aanbevelingen wordt voor een aantal interventies aangegeven dat deze bij voorkeur of uitsluitend in studieverband uitgevoerd moeten worden. Met studieverband bedoelt de werkgroep dat er sprake is van het systematisch registreren en rapporteren van patiëntkenmerken, diagnostiek, behandeling en uitkomst.

 

Indicatorontwikkeling

Een indicator is een meetbaar kenmerk van de gezondheidszorg met een signaalfunctie voor (een aspect van) de kwaliteit van zorg. Indicatoren maken het de zorgverleners mogelijk om te meten of zij de gewenste zorg leveren en om onderwerpen voor verbeteringen te identificeren. Bij deze richtlijn zullen nog indicatoren ontwikkeld worden.

Zoekverantwoording

Zoekacties zijn opvraagbaar. Neem hiervoor contact op met de Richtlijnendatabase.