Local infiltration with NSAIDs for postoperative analgesia: evidence for a peripheral analgesic action Romsing J, Moiniche S, Ostergaard D, Dahl JB Authors' objectives To investigate the evidence for a peripheral analgesic effect of local infiltration with non-steroidal anti-inflammatory drugs (NSAIDs) in post-operative pain. Searching MEDLINE was searched from 1966 to September 1999, EMBASE from 1989 to August 1999, and the Cochrane library in 1999, using the search terms 'NSAID', 'non-steroidal anti-inflammatory drug', individual drug names, 'postoperative pain', 'local infiltration', 'intra-articular', 'regional' and 'surgical site'. There were no restrictions on publication language. Additional studies were identified from the references lists of retrieved reports. Abstracts and unpublished studies were not considered. Study selection Study designs of evaluations included in the review Randomised controlled trials (RCTs) that were double-blind and had at least 10 patients per treatment group. Specific interventions included in the review Comparisons were made with NSAIDS administered intravenously or intramuscularly, or with placebo or no treatment. Comparisons had to be of a local NSAID with the same dose of systemic NSAID, of a local NSAID with placebo or no treatment, or of different doses of a local NSAID. The interventions included in the review were local infiltration with NSAIDs (30 or 60 mg ketorolac; 5, 7.5, 10 or 20 mg tenoxicam) administered either by intra-articular injection (i.a.), as intravenous regional anaesthesia (IVRA) or intra-wound (i.w.). Participants included in the review All patients with post-operative pain were eligible for inclusion in the review; of those studies included, participants were undergoing various surgical procedures such as arthroscopy, elective hand surgery, herniorrhaphy, mastectomy and tonsillectomy. There was a link between the mode of local application of NSAID and the type of surgery undergone by the participants. All studies of i.a. injection of NSAIDs involved patients undergoing arthroscopy. All studies of IVRA involved patients undergoing elective hand surgery. Studies of i.w. application were more varied, involving studies of patients undergoing herniorrhaphy, mastectomy and one each of elective hand surgery and tonsillectomy. Outcomes assessed in the review Difference between the treatments were assessed using pain scores, consumption of supplementary analgesics and/or time to first analgesic request. Weighted mean differences of visual analogue scale (VAS) scores were calculated. How were decisions on the relevance of primary studies made? The authors do not state how the papers were selected for the review, or how many of the authors performed the selection. Assessment of study quality Studies were assessed for the adequacy of randomisation, blinding and description of withdrawals. Included studies (all double-blind RCTs) were scored between 2 and 5. All of the authors independently performed the quality assessment process. Data extraction The authors do not state how the data were extracted for the review, or how many of the authors performed the data extraction. Information about drugs and doses, number of patients enrolled and analysed, types of surgery and anaesthesia (general or regional), study design, observation periods, outcome measures, and adverse effects was Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2018 University of York Page: 1 / 3