To systematically evaluate the efficacy and safety of injectable non-steroidal anti-inflammatory drugs (NSAIDs) for postoperative analgesia.

A comprehensive literature search was conducted across databases including CNKI, WanFang, VIP, SinoMed, PubMed, Embase, Web of Science, and the Cochrane Library, supplemented by clinical trial registries, from inception to September 2025. The Cochrane Risk of Bias tool was utilized to assess the methodological quality of the included studies. Data synthesis and Meta-analysis were performed using RevMan 5.4 and Stata software.

A total of 58 studies involving nine injectable NSAIDs were included. Compared with placebo, all evaluated NSAIDs significantly reduced cumulative opioid consumption at 24 hours postoperatively (all P<0.05). Notably, binaprofen exhibited the most substantial opioid-sparing effect (pooled reduction rate: 36.8%, 95% CI: 32.0% to 40.0%). Furthermore, binaprofen significantly decreased the requirement for patient-controlled analgesia (PCA) rescue [RR=0.42, 95%CI(0.30, 0.58), P<0.001] and the number of effective PCA demands at 24 h. Regarding analgesic efficacy, both parecoxib and ibuprofen significantly lowered pain scores at 24 h postoperatively (both P<0.001). In terms of safety, parecoxib significantly reduced the risk of overall adverse events [RR=0.61, 95%CI (0.51, 0.73)] and gastrointestinal events [RR=0.67, 95%CI (0.54, 0.85)]. Binaprofen also demonstrated a favorable safety profile.

Injectable NSAIDs effectively alleviate postoperative pain and exert a significant opioid-sparing effect, with parecoxib and binaprofen demonstrating favorable safety profiles. Future well-designed studies should focus on the dose-response relationship and long-term safety in specific patient populations.