A RISK-BENEFIT APPRAISAL OF INJECTABLE NSAIDS IN THE MANAGEMENT OF POSTOPERATIVE PAIN

The inadequacy of pain treatment has been demonstrated in many patient groups suffering from acute pain. The injectable nonsteroidal anti-in flammatory drugs (NSAIDs), including indomethacin, diclofenac, ketopro fen and ketorolac, provide relief from the pain associated with severa l different conditions. When administered alone or in combination with low doses of opioids, NSAIDs provide good pain relief after musculosk eletal trauma or operation. The main advantage of these agents is that they may form the first-line therapy for pain relief and thus decreas e the need of opioids. This avoids respiratory depression which can be associated with opioids. In contrast to opioids, NSAIDs do not cause respiratory depression or have marked adverse effects on the central n ervous system. However, they may be associated with adverse effects of the gastrointestinal tract, liver and kidneys, and may increase pre- and postoperative bleeding and cause allergic reactions. These effects are related to the ability of NSAIDs to inhibit prostaglandin synthes is. Use of NSAIDs has to be considered carefully in patients with asth ma, allergy to aspirin and NSAIDs, atopy, peptic ulcer or bleeding dis orders (such as abnormalities in blood coagulation or coagulation defi cits). These considerations are especially important in elderly patien ts. Having taken these contraindications into account, many clinical s tudies have demonstrated that NSAIDs are at least as safe as opioids w hen administered in the short term. However, few studies have specific ally monitored adverse effects or included patients over 65 to 70 year s of age. In addition, patients with risk factors have often been excl uded from the trials. Therefore, the risk-benefit ratio of NSAIDs requ ires further assessment.