University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


General Surgery


Dr. Nancy Reid



Purpose: The purpose of this article is to review the current guidelines for Enhanced Recovery After Surgery (ERAS) following colorectal surgery with nonsteroidal anti-inflammatory drugs (NSAID) use and its association with anastomotic leaks.

Method: A Medline literature search was conducted with search terms colorectal surgery, nonsteroidal anti-inflammatory drugs, and anastomotic leaks. Seventeen relevant articles served as the basis for this clinical review. This group was further refined to analyze selective vs non-selective NSAIDs to assess the overall risk of anastomotic leaks.

Results: The use of NSAIDs postoperatively was associated with an overall increased risk of anastomotic leaks. This risk varied with the type of NSAID taken for pain control: selective vs non-selective. Non-selective NSAIDs had an increased risk while selective NSAIDs appeared safe.

Conclusion: NSAIDs are an important aspect of the ERAS guidelines to improve patient outcomes after surgery. They provide an alternative option for pain control for opioid medications and their known side effects. Recent literature varies in the risk profiles and safety of different classes of NSAIDs. Postoperative use of NSAIDs, particularly diclofenac, is associated with increased risk for anastomotic leak following colorectal surgery.

Keywords: Colorectal surgery, nonsteroidal anti-inflammatory drugs, anastomotic leaks.


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