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Intravenously Administered Nonsteroidal Anti-Inflammatory Drugs in Clinical Practice: A Narrative Review.
Axel Maurice-Szamburski1, Cyril Quemeneur2,3, Romain Rozier4
1Department of Anesthesiology and Critical Care, Pasteur University Hospital, 06300 Nice, France.
Pharmacy (Basel, Switzerland)
|February 25, 2025
Summary
Intravenous nonsteroidal anti-inflammatory drugs (NSAIDs) effectively manage perioperative pain, reducing opioid use by up to 60%. Intravenous ibuprofen shows a favorable profile for pain relief and opioid sparing in adults and children.
Area of Science:
- Anesthesiology
- Pharmacology
- Pain Management
Background:
- Intravenously administered nonsteroidal anti-inflammatory drugs (NSAIDs) are integral to multimodal analgesia in surgical care.
- Their efficacy and safety for perioperative pain in adults and children require current evaluation.
Purpose of the Study:
- To review the efficacy, safety, and clinical application of intravenous (IV) NSAIDs for perioperative pain management.
- To evaluate NSAIDs and selective COX-2 inhibitors (coxibs) approved in Europe for acute, moderate perioperative pain.
Main Methods:
- Narrative review of European-approved IV NSAIDs including ibuprofen, ketorolac, ketoprofen, naproxen, paracetamol, and acetylsalicylic acid.
- Analysis influenced by US and global guidelines and clinical practice.
Main Results:
- IV NSAIDs reduce postoperative opioid consumption by approximately 20-60%, enhancing pain management and minimizing opioid side effects.
- IV ibuprofen demonstrated a favorable profile for opioid sparing and pain relief, with a faster onset than oral forms.
- Adverse event frequency for IV ibuprofen and paracetamol appears similar; IV ibuprofen is preferred for infants and those unable to take oral medication.
Conclusions:
- Intravenous NSAIDs are valuable for perioperative pain management, offering significant opioid reduction.
- IV ibuprofen presents a favorable option, particularly for pediatric patients and those with oral administration challenges.
- Further head-to-head trials comparing IV NSAIDs are recommended to refine clinical practice.
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