Summary of findings 2. NSAID compared to other analgesic in women undergoing breast surgery.
| NSAID compared to other analgesic in women undergoing breast surgery | |||||||
| Patient or population: women undergoing breast surgery Setting: inpatient and outpatient Intervention: NSAID Comparison: other analgesic | |||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments: types of NSAIDs; types of other analgesics | ||
| Risk with other analgesic | Risk with NSAID | ||||||
| Incidence of breast hematoma within 90 days of breast surgery | 20 per 1000 | 7 per 1000 (0 to 160) | RR 0.33 (0.01 to 7.99) | 100 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,c,d,e,f | celecoxib; hydrocodone | |
| Pain intensity 24 (± 12) hours following surgery | The mean pain intensity 24 (± 12) hours following surgery ‐ perioperative was 0 | SMD 0.68 lower (0.97 lower to 0.39 lower) | ‐ | 200 (3 RCTs) | ⊕⊕⊝⊝ Lowa,b,c,d,i | celecoxib, flurbiprofen, ibuprofen; fentanyl, hydrocodone, hydromorphone | |
| Postoperative | The mean pain intensity 24 (± 12) hours following surgery ‐ postoperative was 0 | SMD 0.12 lower (0.51 lower to 0.27 higher) | ‐ | 100 (2 RCTs) | ⊕⊕⊕⊝ Moderatea | flurbiprofen, ibuprofen; fentanyl, hydromorphone | |
| Incidence rate or severity of postoperative nausea, vomiting, or both | 243 per 1000 | 44 per 1000 (15 to 138) | RR 0.18 (0.06 to 0.57) | 128 (3 RCTs) | ⊕⊕⊕⊝ Moderatea,c | ketorolac, ibuprofen, flurbiprofen; morphine, hydromorphone, fentanyl | |
| Bleeding from any location within 90 days | 20 per 1000 | 7 per 1000 (0 to 160) | RR 0.33 (0.01 to 7.99) |
100 (1 RCT) |
⊕⊝⊝⊝ Very lowa,b,c,d,e,f | celecoxib; hydrocodone | |
| Other side effects of NSAID use | 233 per 1000 | 26 per 1000 (2 to 420) | RR 0.11 (0.01 to 1.80) | 48 (1 RCT) | ⊕⊝⊝⊝ Very lowe,f,g | ibuprofen; hydromorphone | |
| Opioid use within 24 (± 12) hours of surgery | The mean opioid use within 24 (± 12) hours of surgery ‐ perioperative was 0 | SMD 6.87 lower (10.93 lower to 2.81 lower) | ‐ | 178 (3 RCTs) | ⊕⊕⊝⊝ Lowa,b,c,d,i | celecoxib, ketorolac, flurbiprofen; hydrocodone, morphine, fentanyl | |
| Postoperative | The mean opioid use within 24 (± 12) hours of surgery ‐ postoperative was 0 | SMD 9.56 lower (18.48 lower to 0.64 lower) | ‐ | 78 (2 RCTs) | ⊕⊕⊝⊝ Lowa,c,g,i | ketorolac, flurbiprofen; morphine, fentanyl | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; NSAID: nonsteroidal anti‐inflammatory drug; RCT: randomized controlled trial; RR: risk ratio; SMD: standardised mean difference. | |||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | |||||||
We downgraded by 1 point for ≥ 1 of the following and 2 points for > 4 of the following due to risk of bias.
aUnclear or high risk selective reporting. bUnclear or high risk allocation concealment. cUnclear or high risk blinding of outcome assessment. dUnclear or high risk blinding of participants and personnel.
We downgraded by 1 point for each of the following
eImprecision. fSingle study. gSample < 100 participants. hHeterogeneity > 50%. iHeterogeneity > 75%.