[NSAID demonstrate convincing effect on postoperative pain]

Non-steroidal antiinflammatory drugs (NSAID) are increasingly being included in the management of postoperative pain as part of a multimodal therapeutic approach. However, there is an ongoing debate among clinicians as to the perioperative use of NSAID's as many authors have cautioned against their use in this setting. Concerns about their impact on coagulation and renal function as well as a risk for gastrointestinal bleeding have been raised. However, many of the adverse effects reported have occurred during long term treatment and might not be directly applicable to the perioperative period. Still the clinician must be aware of the potential risks and benefits of these drugs. This review focuses on the pro's and con's of perioperative NSAID usage. We address the background for a multimodal approach to postoperative pain relief as well as potential alternatives to NSAID's and the recently introduced COX2-selective inhibitors.