Variation in postoperative non-steroidal anti-inflammatory use after colorectal surgery: a database analysis

BACKGROUND: Non-steroid anti-inflammatory drugs (NSAIDs) have been proposed as part of a multimodal post-operative analgesia in patients operated for colorectal cancer. However, whether these drugs are prescribed and taken by the patients have not been evaluated. The aim of this study was to quantify the postoperative use of NSAIDs in these patients.

METHODS: Data from patients operated for colorectal cancer between January 1, 2006 and December 31, 2009 were collected from the Danish Colorectal Cancer Group's (DCCG) prospective database. From the electronically registered medical records, data for the use of the two NSAIDs diclofenac and ibuprofen were recorded. The data from six colorectal departments in eastern Denmark were compared.

RESULTS: Of the 2,754 patients analyzed overall, 40.6% received NSAIDs as part of their analgesic treatment. The percentage of the patients receiving NSAIDs, receiving a pre-defined dosage as a minimum and receiving NSAIDs as p.r.n. medication, and the type of NSAID were significantly different both between department and within departments. The median dose of ibuprofen and diclofenac were 1200 mg (400-2,400 mg) and 100 mg (50-200 mg), respectively.

CONCLUSIONS: The large variation between and within the departments points to an inconsistency in the use of multimodal post-operative pain treatments. This may be a result of insufficient evidence on procedure specific pain treatments and possibly a lack of compliance to existing guidelines. High-quality large-scale studies are warranted to form the basis for guidelines for post-operative analgesic treatment.