Jurnal Pijar MIPA https://jurnalfkip.
id/index.
php/JPM ISSN 1907-1744 (Prin.
ISSN 2460-1500 (Onlin.
The Effectiveness of Non-Steroidal Anti-Inflammatory Drugs (NSAID.
and NSAID-Analgesic Combinations in Optimizing Postoperative Pain Management:
A Review Elsyifa Salsabila.
Mally Ghinan Sholih*.
Diyanah Fauziyah Tamimah Department of Pharmacy.
Faculty of Health Sciences.
Universitas Singaperbangsa Karawang.
West Java.
Indonesia e-mail: mally.
ghinan@fkes.
Received: November 8, 2025.
Accepted: March 3, 2026.
Published: April 6, 2026 Abstract: Postoperative pain is a common clinical problem resulting from tissue trauma and inflammatory responses, which can hinder patient recovery.
One of the most widely used pharmacological therapies is Non-Steroidal Anti-Inflammatory Drugs (NSAID.
, either as monotherapy or in combination with other analgesics.
This study aims to evaluate the effectiveness of NSAIDs, both as single agents and in combination therapy, in reducing postoperative pain.
The study employed a Systematic Literature Review (SLR) method, with literature searches conducted in the PubMed and Google Scholar A total of 588 articles were identified, of which 20 studies met the inclusion criteria and were analyzed using a narrative synthesis approach based on pain intensity parameters, including the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS).
The results indicate that NSAIDs such as ketorolac, ketoprofen, ibuprofen, diclofenac sodium, and dexketoprofen trometamol effectively reduced postoperative pain intensity, with several studies reporting a decrease in VAS scores from moderate pain levels (VAS >.
to mild pain levels (VAS <.
within 24 hours postoperatively.
Furthermore, combination therapy of NSAIDs with paracetamol or tramadol demonstrated superior analgesic efficacy, longer pain-free duration, and reduced opioid requirements compared to NSAID monotherapy, without a significant increase in adverse NSAIDs are effective in postoperative pain management.
Combination therapy with other analgesics such as paracetamol or tramadol provides more optimal outcomes compared to monotherapy.
However, the selection of analgesic agents, dosage, and duration of therapy should be individualized according to the patientAos clinical condition to ensure both safety and therapeutic effectiveness.
Keywords: Combination Analgesics.
NSAIDs.
Postoperative Pain.
Postoperative Pain Management.
Introduction Surgery is one of the most common medical procedures performed for therapeutic purposes, involving the insertion of instruments into the body to access and treat specific areas.
The period following this procedure is called the postoperative phase.
During this phase, patients often experience various discomforts, with pain being the most frequently reported symptom .
Postoperative pain is a common clinical problem that arises from tissue trauma, surgical manipulation, and inflammatory responses.
represents an unpleasant sensory and emotional experience resulting from tissue damage during surgical procedures, typically lasting for about three to seven days after surgery .
Pain is an unpleasant sensory and emotional experience .
Patients undergoing surgery commonly experience several postoperative complaints, such as pain at the surgical wound site, which may subsequently lead to fear of movement or early mobilization .
Severe pain may hinder the implementation of early mobilization, which is crucial for accelerating recovery and preventing complications such as deep vein thrombosis and pneumonia.
Delayed mobilization and prolonged hospitalization can lead to increased healthcare costs.
Therefore, postoperative pain management should not only aim to reduce patient discomfort but also play a vital role in promoting faster recovery and improving healthcare efficiency .
According to the World Health Organization (WHO) report in 2019, approximately 148 million patients worldwide underwent surgical procedures .
WHO also reported that approximately 11% of the global disease burden is attributable to conditions that could be treated In Indonesia, data from the Ministry of Health .
indicated that surgical procedures ranked 11th among 50 disease categories treated in hospitals, accounting for 8% of all cases, with an estimated 32% classified as major surgeries .
One of the most widely used pharmacological strategies in postoperative pain management is the administration of Non-Steroidal Anti-Inflammatory Drugs (NSAID.
This class of drugs is well known for its analgesic, antipyretic, and anti-inflammatory effects .
NSAIDs exert their effects primarily by inhibiting cyclooxygenase (COX-1 and COX-.
These enzymes are responsible for catalyzing the production of prostaglandins, which act as inflammatory mediators that increase nociceptor sensitivity and enhance pain perception .
By inhibiting COX enzymes, the production of prostaglandins (PGECC) and prostacyclin (PGICC) is reduced.
These mediators play a crucial role in the inflammatory Their reduction may lead to vasoconstrictive effects ___________ How to Cite:
Salsabila.
Sholih, and D.
Tamimah.
AuThe Effectiveness of Non-Steroidal Anti-Inflammatory Drugs (NSAID.
and NSAID-Analgesic Combinations in Optimizing Postoperative Pain Management: A ReviewAy.
Pijar.
MIPA, vol.
21, no.
2, pp.
248Ae254.
Apr.
https://doi.
org/10.
29303/jpm.
Jurnal Pijar MIPA and increased sodium retention .
In addition, the antiinflammatory and antipyretic properties of NSAIDs provide additional benefits for postoperative patients, particularly in cases with a strong inflammatory response.
Commonly used nonselective NSAIDs include diclofenac, ketorolac, ibuprofen, and meloxicam, whereas the selective cyclooxygenase-2 (COX-.
inhibitor most frequently used is The use of NSAIDs in postoperative pain management has been shown to provide significant and effective analgesia .
Multimodal analgesia has emerged as a pain management strategy recommended by the World Health Organization (WHO) and has been widely adopted in clinical practice .
This strategy combines different classes of analgesic agents that act on various nociceptive pathways.
The primary goal of this approach is to reduce pain intensity while minimizing the use of opioid medications, thereby lowering the risk of opioid-related adverse effects such as nausea, vomiting, constipation, sedation, and respiratory depression .
Opioid-related adverse effects have been associated with negative clinical outcomes, including prolonged hospitalization and increased rates of readmission .
This concept has also given rise to the idea of opioidfree analgesia, considering that opioid-based analgesic techniques, such as intravenous patient-controlled analgesia (IVPCA) or epidural administration, are not always practical for widespread use.
Since its introduction by Kehlet and Dahl .
as the term' combined analgesic regimen,' multimodal analgesia has aimed to achieve optimal pain control through additive or synergistic effects .
When such combinations produce synergistic interactions, the analgesic benefits can be enhanced.
Many combination analgesic regimens are opioid-sparing in nature .
According to the Royal Colleges of Surgeons .
, pain is recognized as the fifth vital sign that should be continuously monitored, alongside other vital parameters .
Meanwhile, the World Health Organization (WHO), together with several pain-related organizations, has emphasized that pain management is a fundamental human In line with this, the Joint Commission International (JCI) has established pain management as both a patient and family right, as well as an integral component of healthcare service standards .
Inadequate pain management in hospitals can lead to serious consequences for both patients and healthcare institutions, including increased patient morbidity and mortality, higher healthcare costs due to complications, reduced quality of care, and lower patient satisfaction .
Despite the widespread use of NSAIDs in postoperative pain management, comprehensive review studies that specifically compare the effectiveness of NSAID monotherapy versus NSAID-based combination analgesic regimens remain limited, particularly those incorporating recent clinical evidence.
Most existing reviews focus on individual analgesic classes or opioid-sparing strategies without providing a detailed comparison of pain intensity outcomes and safety profiles between single-agent and combination therapies.
Therefore, this literature review aims to complement previous research by systematically analyzing and comparing the effectiveness of NSAIDs used as monotherapy and in combination with other analgesics in Volume 21 No.
: 248-254
optimizing postoperative pain management, based on recent studies and clinically relevant pain assessment parameters.
Research Methods This study employed a Systematic Literature Review (SLR) method, comprehensively searching scientific articles and publications in electronic databases, namely PubMed and Google Scholar, using the Publish or Perish software.
The search was conducted using the following adjusted keywords: (AuNSAIDAy or Aunon-steroidal anti-inflammatory drugsA.
and (Auanalgesic combinationAy or Aumultimodal analgesiaA.
AND (Aupostoperative pain managementAy or Aupain management after surgeryA.
Figure 1.
PRISMA Flow Diagram Table 1.
PICO Framework
PICO
Description P (Populatio.
Postoperative patient I (Interventio.
Administration of NSAIDs alone or in combination with other C (Compariso.
NSAID monotherapy compared with combination therapy .
NSAIDs paracetamol or tramado.
, or comparison with other analgesic regimens O (Outcom.
Effectiveness of reducing postoperative pain intensity and side effects In conducting this review, data were collected using the Publish or Perish software, which identified 588 articles from Google Scholar .
and PubMed .
using selected Of these, 303 articles were excluded for duplication or for not being original research, leaving 285.
Subsequently, 105 articles were removed as irrelevant to the topic, leaving 180.
A further 100 articles were excluded because they were published more than 10 years ago, leaving Jurnal Pijar MIPA Volume 21 No.
: 248-254
80 articles.
Selection was then continued based on the availability of full text and meeting the inclusion criteria, with 60 articles excluded because their full texts were unavailable, leaving 20 articles.
After a thorough screening based on the predefined inclusion criteria, 20 relevant articles were identified and analyzed further.
A Systematic Literature Review (SLR) approach was employed to support a PICO-based analytical framework.
This method enabled the selection of relevant literature from various scientific databases, ensuring comprehensive coverage of the role of NSAIDs and analgesic combinations in optimizing postoperative pain management.
Through this approach, the findings were presented in a structured manner, facilitating readers' understanding, comparison, and interpretation of the evidence, thereby allowing clear conclusions to be drawn from the reviewed studies .
The literature search utilized relevant keywords to maintain focus on the effectiveness of NSAID use both as monotherapy and in combination with other analgesic agents in reducing postoperative pain intensity.
The selected articles were analyzed using a narrative synthesis method.
Pain intensity was evaluated using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS).
The VAS is presented as a 10 cm horizontal line, with 0 indicating no pain and 10 representing the worst imaginable pain.
The NRS is a numerical rating system Table 2.
Monotherapy NSAID
NSAID
Efficacy Ketorolac Reduces pain after orthopedic surgery Ketorolac Reduces pain on the first postoperative day Ketorolac Reduces pain after cesarean section Ketorolac Reduces pain after cesarean section Ketoprofen Reduces pain after cesarean surgery Ketoprofen Ibuprofen Preventive ketoprofen suppository Preventive use after tonsillectomy Ibuprofen Preventive use after dental implant surgery Ibuprofen Reduces pain and morphine requirement Ibuprofen Preventive use after breast tumor surgery ranging from 0 to 10, in which patients are asked to quantify their perceived pain intensity, where higher scores reflect greater pain severity .
Study findings were systematically grouped and compared by NSAID type .
onotherapy or combination therap.
, surgical procedure, pain assessment tools (VAS and NRS), and reported clinical The effectiveness of analgesic therapy was evaluated by comparing changes in pain intensity scores, pain relief duration, and the need for additional or rescue This approach enabled a structured comparison of postoperative pain management outcomes across different analgesic strategies.
Results and Discussion Based on the analysis of 20 journals discussing the use of Non-Steroidal Anti-Inflammatory Drugs (NSAID.
for postoperative pain management across various surgical procedures, including dental, orthopaedic, abdominal, appendectomy, breast tumor, arthroplasty, and obstetric surgeries, it was found that NSAID administration, either as monotherapy or in combination, effectively reduced postoperative pain intensity.
However, most studies reported that combination therapy achieved a greater reduction in pain intensity compared to NSAID monotherapy .
Parameter Pain reduction observed Nilai NTT 30 mg =3.
VAS from 4.
68 A 1.
52 A 1.
Ketorolac 30 mg IV comparable to tramadol 1.
mg/kg IV .
>0.
VAS from 4.
63 A 2.
22 to 1.
76 A 1.
Ae24.
Reference .