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Expert's view The role of NSAIDs in the Post-operative headache

Assoc. Prof. Elena Copaciu
Head of Anesthesia and ICU Department University Hospital, Bucharest, Romania
President of Romanian Association for Pain Study

1) In your experience what is the proportion of patients who experience headache in the post-operative period?

Postoperative headache is not an infrequent event, and it has a major impact on patients' well-being and quality of life in the first period after surgery. I do not have a personal database on this topic, but literature data indicate a prevalence of 24%-54%. Postoperative headache may be caused by hypoglycemia and/or dehydration due to prolonged fasting, caffeine withdrawal, anxiety, and can be associated with preexisting migraine or headache. It is important to remind that it may also be the symptom of serious or even life-threatening events like hypertension, intracranial hemorrhage, or raised intracranial pressure. We should never ignore a postoperative headache in any patient!

2) What is the role of NSAIDs in the management of this kind of pain?

The so-called minor analgesics, paracetamol and NSAIDs, are the first line pharmacological approaches to postoperative headache. In patients without contraindications, NSAIDs should be preferred to paracetamol, thanks to their superior anti-inflammatory effects.

3) In your experience, is there any difference among the several molecules belonging to this pharmacological family from a clinical point of view? Is there any specific reason for choosing a specific NSAID?

As a postoperative symptom, headache is always a cause of concern for patients, their family, and healthcare professionals. When choosing a NSAID for the treatment of postoperative headache, criteria such as the rapid onset of the analgesic effect, the long duration of action, and the level of pain relief are of special importance.

4) What is your experience with the use of nimesulide in patients with this kind of headache?

In our experience nimesulide, thanks to the rapid onset of pharmacological action, good pain relief and stable effect for many hours is an ideal drug for the management of postoperative headache. Of course, this is true in patients with no contraindications for the use of NSAIDs. In general, a treatment with nimesulide for 24-48 hours after surgery is safe and effective, with good patient compliance. I suggest my patients who need to continue the analgesic therapy after discharge to inform their doctor regarding the use of nimesulide during hospitalization.

5) On the basis of your clinical experience, what is your opinion about the benefit-risk profile of nimesulide?

When used in the immediate postoperative period, with the patient monitored by trained healthcare professionals, nimesulide is a very good option. In particular, patients appreciate the fast pain relief and the level of pain control induced by this NSAID. Physicians must accurately select patients with no contraindications and monitor possible side effects. Nevertheless, the short duration of this therapy reduces the risks associated with the long-term use of NSAIDs, including nimesulide.

HELSINN Last Update: 22.02.2013
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