Nonsteroidal Anti-Inflammatory Drugs in Total Joint Arthroplasty

Guideline Question 1

• 1A

  An oral NSAID administered either preoperatively and/or in the early postoperative period reduces pain and opioid consumption following primary TJA.

  StrongTreatment
• 1B

  Administration of an oral selective clyclooxygenase-2 (COX-2) NSAID immediately preoperatively, compared to early postoperative administration, provides improved postoperative pain control and reduced opioid consumption following primary TJA.

  ModerateTreatment

Guideline Question 2

• 2A

  Administration of an oral selective COX-2 NSAID after discharge reduces pain and opioid consumption during the six-week period following a primary total knee arthroplasty (TKA).

  ModerateTreatment
• 2B

  In the absence of reliable evidence, it is the opinion of the workgroup that oral selective COX-2 NSAIDs may be used after discharge as part of a multimodal pain regimen to reduce postoperative pain and opioid consumption in patients undergoing primary total hip arthroplasty (THA).

  ConsensusTreatment

Guideline Question 3

• 3A

  Administration of IV ketorolac preoperatively, intraoperatively, or within 24 hours postoperatively reduces pain and opioid consumption postoperatively (within the first 48 hours) following primary TJA.

  StrongTreatment
• 3B

  Low-dose (15 mg) and high-dose (30 mg) administration of IV ketorolac immediately postoperatively are equivalent at reducing pain and opioid consumption postoperatively (within the first six hours) following primary TJA.

  ModerateTreatment

Guideline Question 4

• 4

  Oral or IV NSAIDs administered preoperatively, intraoperatively, or postoperatively do not appear to increase the risk of medical complications following primary TJA; however, providers should consider patient comorbidities, the type of NSAID administered, dose, and duration of administration.

  LimitedManagement

Therapeutic Area

Guideline Scope

Care Settings