LIMITED RECOMMENDATION The Opioid Combination/NSAID recommendation has been downgraded one level because of inconsistent evidence and the harm of opioids.
There is one high quality study (Bali 2016) showing limited significant difference in pain or opioid use between opioid combinations and NSAIDs.
Benefits/Harms of Implementation
Multimodal analgesia incorporating oral opioids and NSAIDs is standard of care for managing orthopedic postoperative pain. Using a combination of oral opioids and NSAIDs will decrease parenteral opioid use and subsequently decrease opioid-related side effects, such as nausea, vomiting, and respiratory depression. There are no obvious harms to implementing this practice.
Outcome Importance
Targeting multiple pain pathways with multimodal analgesics including oral opioids and NSAIDs will decrease parenteral opioid use and side effects. In addition, it may decrease the amount of NSAIDs needed which could decrease the risks associated with NSAID use, such as renal and GI dysfunction.
Cost Effectiveness/Resource Utilization
Oral opioids and NSAIDs are commonly used and are both relatively inexpensive medications. Oral route of administration is significantly less expensive than parenteral medication administration.
Acceptability
Oral opioids and NSAIDs are both widely accepted medications for treating postoperative pain
Feasibility
This recommendation does not significantly change clinical practice as these medications are both widely used.
Future Research
Future research should focus on determining the most effective combination and dose of medications.