Abstract

PLENGE, Ulla et al. Development of an NSAID decision tool for perioperative pain management in adult orthopaedic patients: a modified Delphi study. SA orthop. j. [online]. 2025, vol.24, n.3, pp.138-146. ISSN 2309-8309.  https://doi.org/10.17159/2309-8309/2025/v24n3a6.

BACKGROUND: Orthopaedic surgery is rated among the most painful of surgeries, leaving patients at risk of experiencing moderate to severe postoperative pain. A multimodal analgesic approach helps reduce opioid requirements, with nonsteroidal anti-inflammatory drugs (NSAIDs) playing a key role in this strategy, provided they are not contraindicated. However, only limited guidance exists for safe perioperative NSAID use in orthopaedic patients with comorbidities. The objective of the study was to achieve consensus on safe, short course (< 1 week) administration of NSAIDs in adult orthopaedic patients with comorbidities, and to convert the results into a decision tool to aid clinicians in safe perioperative NSAID administration METHODS: A Delphi panel of 18 experienced orthopaedic surgeons, physicians and anaesthetists participated in a three-round Delphi process. The panel assessed 42 patient characteristics using a nine-point Likert scale in the first two rounds. After the second round, consensus was defined as > 75% either 'disagreeing' (Likert scale 1-3) or 'agreeing' (Likert scale 7-9) that NSAIDs ± proton pump inhibitors (PPIs) could or could not be administered safely. Characteristics without consensus by round 2 moved to round 3, where subspecialty experts conducted a rapid review of the literature. Consensus in this round required > 75% support for expert recommendations RESULTS: All panel members participated in the first and third rounds, with 16 in the second. After the second round, consensus was achieved for 24 of 42 patient characteristics. However, in preparation for the third round, three characteristics which had achieved consensus after round 2 were added to the pool of characteristics to be considered by subspeciality experts, resulting in 21 proceeding to the third round. In round 3, consensus for all remaining subspeciality expert recommendations was achieved and an NSAID decision tool with guidance in safe perioperative NSAIDs use ± PPIs was subsequently developed for the 42 patient characteristics CONCLUSION: This study establishes a consensus on short-term NSAID administration in adult orthopaedic patients with comorbidities, offering a decision tool to guide clinicians in safely incorporating NSAIDs into perioperative pain management strategies Level of evidence: 5

Keywords : NSAIDs; decision tool; perioperative pain management; orthopaedic surgery; multimodal analgesia; Delphi consensus.

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