Analgesic effects of different administration routes of non-steroidal anti-inflammatory drugs in orthopedic postoperative pain management: a meta-analysis based on randomized controlled trials

OBJECTIVE: To explore the differences in the efficacy and safety of different administration routes (oral, intravenous, intramuscular) of non-steroidal anti-inflammatory drugs (NSAIDs) in orthopedic postoperative pain management. METHODS: Randomized controlled trials were systematically retrieved from PubMed, Medline, Web of Science, Cochrane Library, and EMBASE databases. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool (RoB tool), and meta-analysis was performed using RevMan 5.3 software. The experimental group received NSAIDs via oral, intravenous, or intramuscular routes, while controls received neither NSAIDs nor other analgesics. The primary outcome measures included analgesic drug usage and the occurrence of adverse reactions. RESULTS: 5 studies were included, involving 7971 patients, with 3340 cases in the oral group, 107 cases in the intravenous group, and 982 cases in the intramuscular group. There was no significant difference in the risk of adverse reactions among different administration routes of NSAIDs in orthopedic postoperative patients (RD = 0.00, 95% CI [-0.01-0.02], P = 0.66). The use of analgesic drugs in the treatment group (NSAIDs groups with different administration routes) was significantly less than that in the control group (OR = 0.34, 95% CI [0.23-0.52], P < 0.001). CONCLUSION: Intravenous administration provides significant short-term analgesic effects, oral administration offers stable long-term pain relief. While there is no significant difference in the overall risk of adverse reactions among different administration routes, route-specific reactions exist. Clinicians should select the appropriate administration route based on individual patient conditions.