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Peer-reviewedCC BYFrontiers in pain research (Lausanne, Switzerland)

Use of NSAIDs in orthopedic pain management: a Delphi consensus promoted by the Italian Society of Orthopedics and Traumatology (SIOT)

  • Paolo Tranquilli Leali1
  • Alberto Di Martino2
  • Michele Mercurio3
  • Maria Silvia Spinelli4
  • Flaminia Coluzzi5
  • Francesca Gargano6
  • Lisa Berti2
  • Fabrizio Rivera7
  • Paolo Grossi8
  • Giuseppe Solarino9
  • Alessandro Urbani10
  • Francesco Scaglione11
1 more authors
  • Pietro Simone Randelli11
11 affiliations
  1. 1FBSE, University of Sassari , ,
  2. 2Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna ,
  3. 3Department of Orthopaedic and Trauma Surgery, Magna Græcia University, Renato Dulbecco University Hospital , ,
  4. 4Orthopaedic Oncology Unit, ASST Gaetano Pini-CTO , ,
  5. 5Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome , ,
  6. 6Department of Life Sciences, Health and Health Professions, Link Campus University , ,
  7. 7Cottolengo Hospital , ,
  8. 8Department of Anaesthesia and Intensive Care, ASST Gaetano Pini-CTO , ,
  9. 9University of Bari , ,
  10. 10Freelance Instructor and Facilitator , ,
  11. 11University of Milan , ,
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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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Cite

BibTeXRIS
BibTeX
@article{leali2026nsaids,
  title = {{Use of NSAIDs in orthopedic pain management: a Delphi consensus promoted by the Italian Society of Orthopedics and Traumatology (SIOT)}},
  author = {Paolo Tranquilli Leali and Alberto Di Martino and Michele Mercurio and Maria Silvia Spinelli and Flaminia Coluzzi and Francesca Gargano and Lisa Berti and Fabrizio Rivera and Paolo Grossi and Giuseppe Solarino and Alessandro Urbani and Francesco Scaglione and Pietro Simone Randelli},
  journal = {Frontiers in pain research (Lausanne, Switzerland)},
  year = {2026},
  month = oct,
  doi = {10.3389/fpain.2026.1944515},
  url = {https://europepmc.org/article/PMC/PMC13720948},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Use of NSAIDs in orthopedic pain management: a Delphi consensus promoted by the Italian Society of Orthopedics and Traumatology (SIOT)
AU  - Paolo Tranquilli Leali
AU  - Alberto Di Martino
AU  - Michele Mercurio
AU  - Maria Silvia Spinelli
AU  - Flaminia Coluzzi
AU  - Francesca Gargano
AU  - Lisa Berti
AU  - Fabrizio Rivera
AU  - Paolo Grossi
AU  - Giuseppe Solarino
AU  - Alessandro Urbani
AU  - Francesco Scaglione
AU  - Pietro Simone Randelli
PY  - 2026
DA  - 2026/10/16
JO  - Frontiers in pain research (Lausanne, Switzerland)
DO  - 10.3389/fpain.2026.1944515
UR  - https://europepmc.org/article/PMC/PMC13720948
AB  - 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.
SN  - 2673-561X
ER  -