Non-steroidal anti-inflammatory drugs (NSAIDs) block both cyclo-oxygenase-1 and minus;2. The ratio of potency against cylco-oxygenase-1: potency against cyclo-oxygenase-2 explains the profile of efficacy and side effects of these agents. NSAIDs inhibit nociceptive transmission through C-fibres, but presumably not through Adelta-fibres. They relieve pain and display synergistic effects with opioids when administered intrathecally. The spectre of side effects was in favour of NSAIDs when compared with opioids in only a few controlled studies. A pre-emptive effect of NSAIDs on postoperative pain is still discussed. NSAIDs should be used with caution in the elderly, in the intensive care unit, and in patients with bronchial asthma, reduced renal function, or impaired gastroduodenal mucosal protection.
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