Does the opioid-sparing effect of NSAIDs benefit the patient in the postoperative period?


  • Alexander Ng, MBChB, MD, FRCA
  • Justiaan Swanevelder, MBChB, MMed(Anaes), FCA(SA), FRCA






Author Biographies

Alexander Ng, MBChB, MD, FRCA

Consultant Anaesthetist, The Heart and Lung Centre, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom.

Justiaan Swanevelder, MBChB, MMed(Anaes), FCA(SA), FRCA

Consultant Anaesthetist, Department of Anaesthesia, Critical Care and Pain Management, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.


Ng A, Parker J, Toogood L, et al.: Does the opioid-sparing effect of rectal diclofenac following total abdominal hysterectomy benefit the patient? Br J Anaesth. 2002; 88: 714-716.

Tarkkila P, Saarnivaara L: Ketoprofen, diclofenac or ketorolac for pain after tonsillectomy in adults? Br J Anaesth. 1999; 82: 56-80.

McCrory CR, Lindahl SGE: Cyclooxygenase inhibition for postoperative analgesia. Anesth Analg. 2002; 95: 169-176.

Barden J, Edwards J, Moore RA, et al.: Single dose oral diclofenac for postoperative pain. Cochrane Database Syst Rev. 2004; (2): CD004768.

Edwards JE, Loke YK, Moore RA, et al.: Single dose piroxicam for acute postoperative pain. Cochrane Database Syst Rev. 2000; (4): CD002762.

Buvanendran A, Kroin JS, Tuman KJ, et al.: Effects of perioperative administration of a selective cyclooxygenase 2 inhibitor on pain management and recovery of function after knee replacement. JAMA. 2003; 290: 2411-2418.

Moiniche S, Romsing JMS, Dahl JB, et al.: Nonsteroidal antiinflammatory drugs and the risk of operative site bleeding after tonsillectomy: A quantitive systematic review. Anesth Analg. 2003; 96: 68-77.

Smith LA, Carroll D, Edwards JE, et al.: Single-dose ketorolac and pethidine in acute postoperative pain: Systematic review with meta-analysis. Br J Anaesth. 2000; 84: 48-58.

Jorgensen H, Wetterslev J, Moiniche S, et al.: Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev. 2000; CD001893.

Ng A, Smith G: Gastroesophageal reflux and aspiration in anesthetic practice. Anesth Analg. 2001; 93: 494-513.

Lee A, Done M: The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: A meta-analysis. Anesth Analg. 1999; 88: 1362-1369.

Silverstein FE, Faich G, Goldstein JL, et al.: Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis. The Class Study; A randomized controlled trial. JAMA. 2000; 284: 1247-1255.

Forrest JB, Camu F, Greer IA, et al.: Ketorolac, diclofenac and ketoprofen are equally safe for pain relief after major surgery. Br J Anaesth. 2002; 88: 227-233.

Ng A, Smith G, Davidson AC: Analgesic effects of parecoxib following total abdominal hysterectomy. Br J Anaesth. 2003; 90: 746-749.

Warltier DC, Marret E, Flahault A, et al.: Effects of postoperative, nonsteroidal, anti-inflammatory drugs on bleeding risk after tonsillectomy. Meta-analysis of randomized controlled trials. Anesthesiology. 2003; 98: 1497-1502.

Joshi W, Connelly NR, Reuben SS, et al.: An evaluation of the safety and efficacy of administering rofecoxib for postoperative pain management. Anesth Analg. 2003; 97: 35-38.

Brown KM, Saunders MM, Kirsch T, et al.: Effect of COX-2 specific inhibition on fracture-healing in the rat femur. J Bone Joint Surg. 2004; 86: 116-123.

Bombardier C, Laine L, Reicin A, et al.: Vigor study group. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Engl J Med. 2000; 343: 1520-1528.

Ray WA, Stein M, Daugherty JR, et al.: COX-2 selective nonsteroidal anti-inflammatory drugs and risk of serious coronary heart disease. Lancet. 2002; 360: 1071-1073.

Juni P, Nartey L, Reichenbach S, et al.: Risk of cardiovascular events and rofecoxib: Cumulative meta-analysis. Lancet. 2004; 364: 2021-2029.

Bresalier RS, Sandler RS, Quan H, et al.: Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med. 2005; 352: 1092-1102.

Dieppe PA: Lessons from the withdrawal of rofecoxib. BMJ. 2004; 329: 867-868.

Kimmel SE, Berlin JA, Reilly M, et al.: Patients exposed to rofecoxib and celecoxib have different odds of nonfatal myocardial infarction. Ann Intern Med. 2005; 142: 157-164.

Graham DJ, Campen D, Hui R, et al.: Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective anti-inflammatory drugs: Nested case-control study. Lancet. 2005; 365: 475-482.

Solomon DH, Schneeweiss S, Glynn RJ, et al.: Relationship between selective cyclooxygenase-2 inhibitors and acute myocardial infarction in older adults. Circulation. 2004; 109: 2068-2073.

National Institutes of Health: NIH halts use of COX-2 inhibitor in large cancer prevention trial. Available at Accessed March 31, 2005.

Gottlieb S: Warnings issued over COX-2 inhibitors in US and UK. BMJ. 2005; 330: 9.

Solomon SD, McMurray JJV, Pfeffer MA, et al.: Cardio -vascular risk associated with celecoxib in a clinical trial for colorectal adenoma prevention. N Engl J Med. 2005; 352: 1071-1080.

Nussmeier NA, Whelton AA, Brown MT, et al.: Complications of the COX-2 inhibitors parecoxib and valdecoxib after cardiac surgery. N Engl J Med. 2005; 352: 1081-1091.

Ott E, Nussmeier NA, Duke PC, et al.: Efficacy and safety of the cyclooxygenase 2 inhibitors parecoxib and valdecoxib in patients undergoing coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2003; 125: 1481-1492.

National Institutes of Health: Use of non-steroidal antiinflammatory drugs suspended in large Alzheimer’s disease prevention trial. Available at: Accessed March 31, 2005.

Lloyd K: Important new safety information cardiovascular risk, celecoxib, valdecoxib, parecoxib. Pfizer, Inc.: 2005.

Ray WA, Griffin MR, Stein CM: Cardiovascular toxicity of valdecoxib. N Engl J Med. 2004; 351: 2767.




How to Cite

Ng, MBChB, MD, FRCA, A., and J. Swanevelder, MBChB, MMed(Anaes), FCA(SA), FRCA. “Does the Opioid-Sparing Effect of NSAIDs Benefit the Patient in the Postoperative Period?”. Journal of Opioid Management, vol. 1, no. 2, May 2005, pp. 67-69, doi:10.5055/jom.2005.0017.