Timing of perioperative non-steroidal anti-inflammatory drug treatment

The time of non-steroidal antiinflammatory drug (NSAID) administration may be clinically important because their onset of effect may be delayed by 30-60 minutes while their opioid sparing effect is not apparent until 4 hours after administration. These findings can be explained by the pharmacokinetic behavior of these agents. Numerous studies addressing the short-term benefit of preemptive administration of NSAIDs gave inconclusive results, in part due to the study design. But if a preemptive analgesic effect of NSAIDs was demonstrated in some studies, it was of short duration and had no significant clinical benefit. Also, the risks associated with preoperative NSAID administration, such as operative site bleeding, should be considered against the potential benefits in establishing a treatment regimen.