💊 Nonsteroidal Anti-Inflammatory Drugs for Postoperative Analgesia

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

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.

• Effective pain control
• Opioid-sparing effect
• Non-sedating
• Anti-inflammatory properties

• 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

• Use lowest effective dose for shortest necessary duration
• Assess bleeding risk prior to NSAID administration
• Avoid in patients with:
  1. Active or recent bleeding
  2. Coagulopathy or thrombocytopenia
  3. Severe renal impairment
  4. Peptic ulcer disease

NSAIDs 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.