options using nonsteroidal antiinflammatory drugs in the perioperative period
Perioperative administration of COX-2 inhibitors for total joint arthroplasty has been shown to result in a reduction in perioperative pain and improvement in outcomes without the added risk of increased perioperative bleeding. Currently available nonsteroidal antiinflammatory drugs (NSAIDs) for parenteral administration in United States are ketorolac and diclofenac. The apprehension about ketorolac stems from the fact that it is a reversible cyclooxygenase inhibitor. Postoperative bleeding was not significantly increased with using low-dose ketorolac, and the incidence of adverse events, including postoperative nausea and vomiting, was significantly lower.