Nonsteroidal anti-inflammatory drugs: a difficult choice of anesthesia during joint surgery

Nonsteroidal anti-inflammatory drugs (NSAIDs) are an important component of a multimodal pain management program in patients with rheumatic diseases in the perioperative period. NSAIDs have comprehensive analgesic, antiinflammatory, and antipyretic effects associated with blockade of the enzyme cyclooxygenase-2 and suppression of the synthesis of prostaglandins, one of the main mediators of pain and inflammation, which are synthesized in response to surgical tissue injury. NSAIDs can ease the suffering of patients in the pre- and postoperative periods and reduce the need for opioid analgesics and the frequency of adverse events (AE) caused by the latter. The choice of NSAIDs is largely determined by the risk of AE: gastrointestinal, cardiovascular and postoperative bleeding. The paper considers whether different NSAIDs can be chosen for patients with joint diseases during surgical treatment in terms of their efficacy and safety.