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The Risks of NSAIDs and Surgery – How NSAIDs Can Affect Surgery Recovery

The Risks of NSAIDs and Surgery – How NSAIDs Can Affect Surgery Recovery

chemical forumula of aspirin
Aspirin, or acetylsalicylic acid, is a NSAID

NSAIDs, “non-steroidal anti-inflammatory drugs” provide pain-relief (analgesic effects), reduce fever, and in larger doses are anti-inflammatory.

An important factor for these drugs is that they are non-narcotic, and therefore, non-addictive.

The most well-known NSAIDs are aspirin, ibuprofen, and naproxen, all of which can be obtained over-the-counter in most countries.

How Do They Work?

This part is a bit technical but please bare with me. It’s only a few sentences and helps us understand the side effects of NSAID’s.

NSAIDs work by blocking the function of the enzyme cyclooxygenase (COX), which has two forms, COX-1 and COX-2.

  • COX-1 protects the stomach lining from harsh acids and digestive chemicals, and helps maintain kidney function.
  • COX-2 is produced when joints are injured or inflamed.

Traditional NSAIDs block the actions of both COX-1 and COX-2, which is why they can cause stomach problems and bleeding, as well as control pain and inflammation.

Some NSAIDs belong to a special category of COX-2 inhibitors. One of these is the drug Celebrex®, advertised for the relief of arthritis. (A popular Celebrex substitute are Boswellia caps.)

Two other COX-2 inhibitors, Vioxx® and Bextra®, were withdrawn from the market in 2004 and 2005, respectively.

Treatment Applications



NSAIDs are frequently used to treat inflammatory conditions such as arthritis, bursitis and tendonitis.

What makes these drugs a first-line medication for pain-relief is the fact that NSAIDs are relatively low-cost compared to other pain-relief medications.

In some cases, low-doses of NSAIDs are prescribed for people with cardiac disease. COX-2 inhibitors are more expensive than traditional NSAIDs, and are often prescribed to treat long-term conditions (such as arthritis) because they are less harsh on the stomach.

Potential Side Effects

NSAIDs have been the subject of numerous studies in the medical literature. One of the concerns about NSAIDs is that some medical studies have suggested that these drugs might impair the healing of bone and soft-tissue after injury or surgery.

This is because COX-2 serves an important function as a regulator of skeletal metabolism, and inhibiting it with NSAIDs may alter certain fundamental processes important to the healing of injured tissue.

Bone Healing Impaired by NSAIDs?


broken arm bone in cast
use NSAIDs moderately to be sure not to interfere with bone healing

One 2008 study focused on the effects of celecoxib (Celebrex®), stating that fracture healing and tendon-to-bone healing appear to be particularly susceptible to inhibition by this drug. The article describes how COX is important to the healing process in many skeletal tissues, either directly or indirectly through modulation of the inflammatory response.

Therefore, using NSAIDs during the healing process can profoundly affect skeletal health (O’Connor, J.P., & Lysz, T., 2008 September).

The American Academy of Orthopaedic Surgeons (AAOS) acknowledges that NSAIDs/COX-2 inhibitors may have a delaying effect on bone healing, but the extent of this effect remains unknown.

The AAOS suggests that short-term use of NSAIDs after a fracture or orthopaedic surgery is generally safe (, 2009, January).

NSAIDs Cause Wound Healing Complications?

Another journal article published in 2005 said that NSAIDs affect inflammation and local immune responses, which are necessary for proper wound healing. Using these drugs might result in undesirable postoperative complications, such as wound dehiscence (opening), infection, and impaired collagen synthesis. The end result may lead to delayed healing of soft tissue and bone wounds.

The article suggested large human clinical trials have yet to be conducted to study outcomes regarding use of COX-2 inhibitors and their effect on wound healing. Most of the current information on wound healing originated from animal studies, which do not compare to human trials for discovering if NSAIDs used before or after surgery impairs healing.

The article suggests that the safety and influence of COX-2 inhibitors on wound healing in postoperative patients remain unknown (Busti, Anthony J., Hooper, Justin S., Amaya, Christopher J., & Kazi, Salahuddin, 2005).

In Summary

NSAIDs are important alternatives to addictive narcotic drugs for providing needed pain relief after injury or surgery. However, it is important to consider how NSAIDs function as COX-inhibitors, as these enzymes are also vital to the overall healing process in bones and tissue.

The AAOS suggests that short-term use of NSAIDs post-surgery is generally safe. Patients should consult with their doctors about which drugs they will use to suppress pain during the post-operative period of healing.



Busti, Anthony J., Hooper, Justin S., Amaya, Christopher J., & Kazi, Salahuddin. (2005).

Effects of Perioperative Antiinflammatory and Immunomodulating Therapy on Surgical Wound Healing. Pharmacotherapy, 25(11), 1566-1591. Retrieved from Wiley Online Library



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