====== 💊 Nonsteroidal Anti-Inflammatory Drugs for Postoperative Analgesia ======



===== 🎯 Indications in Postoperative Care =====
NSAIDs are indicated for:
  * **[[Mild pain]] to [[moderate pain]]**
  * As an **[[adjunct]]** to opioids in [[severe pain]]
  * In **multimodal analgesic protocols** to improve pain control and reduce opioid consumption

===== 🧠 Special Considerations in Neurosurgery =====
Historically, the use of NSAIDs in neurosurgery has been limited due to:
  * Concerns about **postoperative bleeding** (platelet dysfunction)
  * Potential for **renal toxicity** and **gastric bleeding**
  * Risk of **intracranial hemorrhage**

However, recent evidence supports their **safe use** after craniotomy:
> Cardoso et al. (*Neurosurgery*, 2025): A meta-analysis of 7 studies found **no significant increase in postoperative bleeding or surgical reintervention** in patients receiving NSAIDs after brain surgery.

===== ✅ Benefits =====
  * Effective pain control
  * Opioid-sparing effect
  * Non-sedating
  * Anti-inflammatory properties

===== ⚠️ Risks =====
  * Gastrointestinal bleeding (especially with COX-1 inhibitors)
  * Platelet dysfunction → theoretical risk of surgical site bleeding
  * Nephrotoxicity in volume-depleted patients
  * Cardiovascular risks with prolonged use

===== 💉 Commonly Used NSAIDs in Postoperative Settings =====
^ Drug ^ Selectivity ^ Route ^ Clinical Notes ^
| Ibuprofen | Non-selective | PO/IV | Common, short half-life |
| Ketorolac | Non-selective | IV/IM | Potent analgesic, higher bleeding concern |
| Diclofenac | Non-selective | PO/IM | Moderate analgesic |
| Celecoxib | COX-2 selective | PO | Lower GI/bleeding risk, good for high-risk patients |

===== 📋 Clinical Guidelines =====
  * Use **lowest effective dose** for **shortest necessary duration**
  * **Assess bleeding risk** prior to NSAID administration
  * **Avoid** in patients with:
    - Active or recent bleeding
    - Coagulopathy or thrombocytopenia
    - Severe renal impairment
    - Peptic ulcer disease

===== 📌 Conclusion =====
[[NSAID]]s are an effective and generally safe component of **[[postoperative analgesia]]**, including after neurosurgical procedures such as [[craniotomy]]. Their use should be guided by **individual risk assessment**, and they are best utilized within a **multimodal analgesic approach**.