Can oral Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) be given to a post gastric sleeve (Bariatric Surgery) patient 6 months after surgery?

From the Guidelines

Oral Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) can be given to a post gastric sleeve (Bariatric Surgery) patient 6 months after surgery, but with caution and preferably for short-term use only, as the stomach has typically healed sufficiently to tolerate NSAIDs at this point 1. When considering the use of oral NSAIDs in patients 6 months post-gastric sleeve surgery, it's essential to weigh the potential benefits against the risks. The primary concern with NSAIDs after bariatric surgery is their potential to cause gastric irritation, ulceration, or bleeding. However, at the 6-month mark, the stomach has typically healed sufficiently from the surgery to tolerate NSAIDs.

• Options for oral NSAIDs include ibuprofen (Advil, Motrin) 200-400 mg every 6-8 hours as needed or naproxen (Aleve) 220-440 mg every 12 hours as needed.
• It's crucial to use the lowest effective dose for the shortest duration possible and to take these medications with food to minimize stomach irritation.
• NSAIDs should be avoided if the patient has a history of gastric ulcers, bleeding disorders, or kidney problems.
• The use of perioperative NSAIDs has been shown to result in a reduction of hospital stay and lowering morbidity in elective surgery 1.
• A study found that perioperative administration of Ibuprofen IV 800 mg every 6 h decreased morphine requirements and pain score and was found safe and well tolerated 1. If pain persists or worsens, it's recommended to consult a healthcare provider, as alternative pain management strategies may be more appropriate for the specific situation.
• Other options for pain management, such as acetaminophen, gabapentinoids, and alpha-2-agonists, can be considered as part of a multimodal analgesia approach 1, 2.
• The combination of NSAIDs with acetaminophen has been shown to improve the quality of pain relief compared to the appointment of each of the drugs separately 1.

From the Research

Oral Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) after Gastric Sleeve Surgery

• The use of oral NSAIDs after gastric sleeve surgery is a topic of interest, with several studies investigating their safety and efficacy 3, 4, 5, 6, 7.
• A study published in 2022 found that there was no association between NSAID exposure and the development of peptic ulcers after sleeve gastrectomy (SG) 3.
• Another study published in 2021 found that NSAID use after SG was high, despite an institutional policy to prohibit their use, and that there were no cases of NSAID-induced gastrointestinal complications in their retrospective review 4.
• A randomized controlled intervention study published in 2016 found that informing patients and their general practitioners about the risks of NSAID use after bariatric surgery did not reduce the use of NSAIDs 5.
• A review published in 2014 discussed the prevention and treatment of NSAID gastropathy, highlighting the importance of safe prescription and the use of proton pump inhibitors (PPIs) to reduce the risk of gastrointestinal adverse events 6.
• A study published in 2023 investigated the solubility and pharmacokinetics of selective COX-2 inhibitors after bariatric surgery, finding that etodolac and celecoxib may be preferred over etoricoxib due to their unaffected absorption after surgery 7.

Safety of Oral NSAIDs 6 Months after Gastric Sleeve Surgery

• The available evidence suggests that oral NSAIDs may be safe to use after gastric sleeve surgery, but it is essential to consider the individual patient's risk factors and medical history 3, 4.
• The use of PPIs may be recommended to reduce the risk of gastrointestinal adverse events 6.
• Selective COX-2 inhibitors, such as celecoxib and etodolac, may be a safer option than non-selective NSAIDs after bariatric surgery 7.

Key Considerations

• Patients should be informed about the potential risks and benefits of oral NSAID use after gastric sleeve surgery 5.
• Healthcare providers should consider the individual patient's risk factors and medical history when prescribing oral NSAIDs after surgery 6.
• Further research is needed to fully understand the safety and efficacy of oral NSAIDs after gastric sleeve surgery 3, 4, 7.