NSAIDs

COX-2

Efficacy for moderate to severe acute pain (numbers needed to treat—NNT)

Diclofenac 50mg (2.3)

Ibuprofen 400mg (2.4)

Ketorolac 10mg (2.6)

Celecoxib 200mg (4.5)

Parecoxib 20mg (3.0)

Valdecoxib 20mg (1.7)

Renal function

Can affect renal function postoperatively

Similar adverse effects on renal function

Gastrointestinal

Acute gastroduodenal damage and bleeding can occur. Risk increased with higher doses, history of GI ulceration, long-term use, and elderly

Less clinically significant peptic ulceration than NSAIDs (VIGOR and CLASS studies)

Platelet function

Inhibit platelet function but do not significantly increase surgical blood loss in normal patients. Associated with higher incidence of post-tonsillectomy haemorrhage

Do not impair platelet function

Aspirin-exacerbated respiratory disease

10–15% of asthmatics affected when given aspirin. Cross-sensitivity with NSAIDs

Do not produce bronchospasm

Bone healing

Impaired in animal models. No good evidence that clinically important

Similar to NSAIDs