Perioperative statins surgery and postoperative pain

In this issue of the British Journal of Anaesthesia, Saasouh and colleagues evaluated whether statins influence postoperative pain and opioid consumption after hip surgery. Using a large and long-established Cleveland Clinic database a group of patients already taking statins were matched with otherwise similar patients who were not. The authors conclude that there was no significant relationship between statin taking and postoperative pain and opioid consumption during the initial 72 h after hip surgery. Statins are among the most widely prescribed drugs. Sixteen per cent of men and 12% of women in the UK are prescribed a statin by their primary care physician. International guidelines recommend statins for high-risk patients with atherosclerotic cardiovascular disease (Table 1). Lower-risk patients are also thought to benefit from the robust cholesterol reduction provided by statins. A recent review evidences the efficacy of sta-tins for both primary and secondary prevention of heart attacks and strokes. Clearly, a significant number of people presenting for surgery will be on long-term statin therapy. If we consider the mechanism of action of statins, it is important to understand how they might impact on pain.