Efficacy of nonsteroidal antiinflammatory drugs in postoperative pain

Historically, NSAIDs, used for more than 25 years to treat rheumatologic diseases, were then introduced to relieve pain after tooth extraction, and finally about 10 years ago for postoperative analgesia. NSAIDs have been increasingly used over the past ten years in the treatment of postoperative pain, such that they now play an important role in the management of postoperative analgesia, either alone or combined with opioids. When used alone, they are effective in relieving minor or moderate pain such as that seen after maxillofacial, minor orthopedic, or some ambulatory surgical procedures, and postpartum pain (episiotomy). In these indications, the main benefit as compared with opioids is the lack of respiratory depression, nausea and vomiting. Since these side effects delay discharge from the hospital after ambulatory surgery, the use of NSAIDs may result in faster recovery and earlier discharge. Because of the ceiling effect of NSAIDs, their efficacy as sole agents is usually insufficient to treat pain after major surgery (orthopedic, abdominal, thoracic). NSAIDs should then be combined with opioids. As part of a balanced analgesia regimen, NSAIDs will allow for opioid-sparing, and might subsequently reduce opioid-mediated side effects. A 20 to 50% reduction in opioid consumption, sometimes with improved quality of analgesia, has been reported using different NSAIDs following various types of surgery. Better respiratory function, improved sleep quality, and faster recovery of gastrointestinal function have been reported with NSAIDs. However, the use of NSAIDs has not been shown to be associated with improved outcome or more rapid recovery.