As per a state-of-the-art review issued in Otolaryngology-Head and Neck Surgery, the use of non-steroidal anti-inflammatory drugs (NSAIDs) plus acetaminophen offers highly effective analgesia for after the operation pain.

Acetaminophen 500 mg plus ibuprofen 200 mg as multimodal analgesia is substantially more effective analgesia as compared to opioid routines (oxycodone 15 mg with acetaminophen). Also, selective cyclooxygenase-2 inhibition constantly avoids anti-platelet effects.

The review was performed to provide realistic, evidence-informed advice on NSAIDs as first-line therapy post-surgery. Considering the American Academy of Otolaryngology-Head & Neck Surgery (AAO-HNS) clinical practice guideline (CPG), the data considered was based on potency, bleeding risk, and adverse effects for ibuprofen, naproxen, meloxicam, and celecoxib.

Database search included Cochrane Library, National Library of Guidelines, NICE, Australian National Health and Medical, PubMed, EMBASE, Agency for Healthcare Research and Quality (AHRQ), etc.

After surgery, NSAIDs alone or in combination with acetaminophen are more likely to lower acute postoperative pain compared to the standard opioid regimens, as shown in the following figure: 

Efficacy depicted on the y-axis is the reciprocal of the number of people needed to treat for 1 person to achieve 50% pain relief (NNT)

The balance of benefit over harm favors nonopioid regimens as the first-line analgesia, as supported by a Cochrane Collaborative meta-analysis of 350 randomized trials, demonstrated double the rate of adverse events with opioids versus NSAIDs, as shown in the following figure:

Thus, as per the AAO-HNS opioid prescribing guideline, the multimodal, non-opioid analgesia can be regarded as first-line therapy, suggesting that opioids be set aside for acute or refractory pain.