SynthesisFrontiers in pain research (Lausanne, Switzerland)2026
Use of NSAIDs in orthopedic pain management: a Delphi consensus promoted by the Italian Society of Orthopedics and Traumatology (SIOT).
Synthesis in Frontiers in pain research (Lausanne, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are a cornerstone of pain management in orthopedics, yet significant variability persists in prescribing practices and adherence to guidelines. Methods: A two-round modified Delphi consensus was conducted under the coordination of a methodologist, involving a scientific board of seven members and a broader expert panel of orthopedic surgeons, anesthesiologists, and pharmacologists affiliated with the Italian Society of Orthopedics and Traumatology (SIOT). Twenty statements spanning four domains-NSAID mechanisms of action, perioperative pain management in elective surgery, traumatic pain, and non-oncological/oncological pain-were submitted for evaluation using a six-point Likert scale; consensus was defined as ≥75% of ratings concentrating within a single tertile. Results: Of the 20 statements, 12 reached consensus in the first round; six revised statements reached consensus in the second round; and two were eliminated because of persistent opinion dispersion. Final recommendations endorse short-cycle NSAID therapy (7-10 days) within multimodal analgesia, support the use of symptomatic slow-acting drugs for osteoarthritis to reduce NSAID consumption in osteoarthritis, recommend NSAIDs perioperatively in frail fracture patients to limit opioid use and delirium, identify ketoprofen lysine salt as having a favorable risk-benefit profile for postdischarge pain, and emphasize individualized NSAID selection based on cardiovascular, renal, and antiplatelet risk factors. Discussion: This SIOT consensus provides evidence-informed, clinically actionable recommendations for NSAID use across the principal orthopedic pain scenarios, aiming to improve prescribing appropriateness and patient safety in routine practice.
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