💊 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

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

💉 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

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.