Effects of nonsteroidal anti‐inflammatory drugs on postoperative renal function in adults with normal renal function

Background Nonsteroidal anti‐inflammatory drugs (NSAIDs) can play a major role in the management of acute pain in the peri‐operative period. However, there are conflicting views on whether NSAIDs are associated with adverse renal effects. Objectives The primary objective of this review was to determine the effects of NSAIDs on postoperative renal function in adults with normal preoperative renal function. Search methods Electronic searches for relevant randomised and quasi‐randomised controlled trials in Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were performed. Attempts were also made to identify trials from citation lists of relevant trials, review articles and clinical practice guidelines. Handsearching of conference s published in major anaesthetic journals was also performed. Selection criteria The inclusion criteria were randomised or quasi‐randomised comparisons of individual NSAIDs with either each other or placebo for treatment of postoperative pain, with relevant postoperative renal outcome measures, in adult surgical patients with normal renal function. Data collection and analysis The data were extracted independently by two authors. The primary outcome measure was creatinine clearance within the first two days after surgery. Secondary outcome measures included serum creatinine, urine volume, urinary sodium level, urinary potassium level, fractional excretion of sodium, fractional excretion of potassium and need for dialysis. Mean differences (MD) for continuous outcomes and risk ratio (RR) and risk difference (RD) for dichotomous outcomes were estimated with 95% confidence intervals (CI). Main results Twenty‐three trials (1459 patients) fulfilled the selection criteria for this review. NSAIDs reduced creatinine clearance by 16 mL/min (95% CI 5 to 28) and potassium output by 38 mmol/day (95% CI 19 to 56) on the first day after surgery compared to placebo. There was no significant difference in serum creatinine on the first day (0 μmol/L, 95% CI ‐3 to 4) compared to placebo. No significant reduction in urine volume during the early postoperative period was found. There was no significant difference in serum creatinine in the early postoperative period between patients receiving diclofenac, ketorolac, indomethacin, ketoprofen or etodolac. No cases of postoperative renal failure requiring dialysis were described. The trials were not heterogeneous for the primary outcome. Authors' conclusions NSAIDs caused a clinically unimp