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.