The nonopioid analgesic group is comprised of acetaminophen and the nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs are appropriate as first-line analgesics for postoperative pain of mild to moderate intensity. Numerous studies have shown that they also produce dose-sparing effects and provide effective pain relief for a wide variety of major surgical procedures as part of a multimodal pain management regimen that combines drugs with different underlying mechanisms of action.1"10 Guidelines recommend the use of multimodal analgesia as a means of reducing postoperative opioid doses and preventing clinically significant opioid-induced adverse effects.11 However, the current availability of only two IV nonopioid analgesic formulations in the United States (ke-torolac and ibuprofen; IV indomethacin is used for closure of patent ductus arteriosus) is a barrier to meeting this objective. Furthermore, postoperative nausea and vomiting and NPO status limit the usefulness of the oral route of administration in many patients. These factors have led researchers and clinicians to focus attention on the use of the rectal route for nonopioid analgesic administration in the perioperative setting. Although analgesic drugs rarely are administered rectally in adults in the perioperative setting in the United States, this route of analgesic administration has a long history of safety in children undergoing surgery and is an attractive alternative when oral or parenteral nonopioid analgesics are not an option.
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