Eficacia analgésica de los antiinflamatorios no esteroideos en monoterapia frente a la analgesia multimodal basada en bloqueos regionales en el manejo del dolor agudo por trauma de extremidades inferiores: revisión sistemática de estudios publicados entre 2015 y 2026

Acute pain secondary to lower extremity trauma represents one of the most common reasons for emergency department visits and poses a clinical challenge due to its intensity, complex pathophysiology, and need for timely analgesic control. Nonsteroidal anti-inflammatory drugs (NSAIDs) have traditionally been used as first-line therapy because of their anti-inflammatory efficacy and favorable short-term safety profile; however, multimodal analgesia incorporating regional nerve blocks has recently gained prominence as a superior opioid-sparing strategy. A systematic review was conducted according to PRISMA 2020 guidelines, including studies published between 2015 and 2026 retrieved from PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. From 500 identified records, 20 studies involving adult patients with acute lower extremity trauma and validated pain scale assessments were included. Findings indicate that NSAID monotherapy is effective in mild to moderate pain, achieving clinically meaningful reductions in pain intensity, but demonstrates limited efficacy in severe pain or unstable fractures. In contrast, regional nerve blocks—such as femoral, fascia iliaca, and PENG blocks—provided faster and greater pain reduction and significantly decreased opioid rescue requirements within the first 24 hours. The evidence supports an individualized and stepwise analgesic model based on trauma severity and pain intensity to optimize outcomes while minimizing opioid exposure.