spensj Posted May 20, 2014 Share Posted May 20, 2014 Had a discussion with one of my sp's yesterday about using nsaids as an adjunct pain med in fractures ....I tend to avoid due to effect on bone healing (?theoretical) but will rx in addition to opioid in very minor, non displaced adult fx's in the ED. My sp told me evidence of nsaid effect on bone healing is ONLY theoretical and can use for essentially any fracture (save for hip fx's, pelvic fx's i assume) . Not sure if I buy this statement. Your thoughts? Link to comment Share on other sites More sharing options...
KMD16 Posted May 20, 2014 Share Posted May 20, 2014 Yes, theoretically (laboratory & animals studies). However, clinical studies lacking or insufficient data. I think for minor fx's, the use of NSAIDs as an adjunct therapy is OK. NSAIDs use post major surgery e.g spinal fusion not OK usually first few weeks post spinal surgery. Anyway. I suggest you do a literature search. Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 20, 2014 Moderator Share Posted May 20, 2014 data was for HIGH dose in the studies I give 200mg TID for the fracture patients - seems to help a lot Link to comment Share on other sites More sharing options...
hlj25950 Posted May 20, 2014 Share Posted May 20, 2014 Literature is mixed. I'd avoid NSAIDS for fracture healing, if possible. Link to comment Share on other sites More sharing options...
dmdpac Posted May 20, 2014 Share Posted May 20, 2014 Most of the orthos in my area have asked us (in the ED) not to prescribe NSAIDs for fractures or suspected fractures. Take that for what it's worth. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted May 20, 2014 Moderator Share Posted May 20, 2014 Ortho I've worked with hounds on the NSAID thing. Personally though, I would look at the age of the patient and type of fracture to see risk of nonunion and then decide. Link to comment Share on other sites More sharing options...
primadonna22274 Posted May 20, 2014 Share Posted May 20, 2014 Use them all the time, except for osteoporosis or Paget dz patients, a population in which I would likely avoid NSAIDs anyway. Theoretical but not clinically important effect on bone healing. The pain relief for NSAIDs is quite superior to opiates for mild-moderate fx. Especially useful in children! Link to comment Share on other sites More sharing options...
KMD16 Posted May 20, 2014 Share Posted May 20, 2014 +1 It also depends on surgeon's preference. Link to comment Share on other sites More sharing options...
primadonna22274 Posted May 20, 2014 Share Posted May 20, 2014 Oh sure but I'm thinking of all the nonsurgical fx I treat. Far more of those than surgical. Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 21, 2014 Moderator Share Posted May 21, 2014 Oh sure but I'm thinking of all the nonsurgical fx I treat. Far more of those than surgical. to data was for HIGH dose in the studies I give 200mg TID for the fracture patients - seems to help a lot Oh sure but I'm thinking of all the nonsurgical fx I treat. Far more of those than surgical. to clairfy my above statement this is only for patients I see in express care that are simple non-surgical fractures - ie non-displaced medial mal fx in otherwise healthy (good kidney function) younger person Surgery patients - heck I don't deal with them post op nasty fractures - not my field simple little fractures that will be casted and heal on their own - 200mg Ibu TID, then some T3 of vicodin is usually more then enough - Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 21, 2014 Moderator Share Posted May 21, 2014 Oh sure but I'm thinking of all the nonsurgical fx I treat. Far more of those than surgical. data was for HIGH dose in the studies I give 200mg TID for the fracture patients - seems to help a lot to clairfy my above statement this is only for patients I see in express care that are simple non-surgical fractures - ie non-displaced medial mal fx in otherwise healthy (good kidney function) younger person Surgery patients - heck I don't deal with them post op nasty fractures - not my field simple little fractures that will be casted and heal on their own - 200mg Ibu TID, then some T3 of vicodin is usually more then enough - Link to comment Share on other sites More sharing options...
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