Pain management is evolving, but some of the most meaningful improvements come from looking more closely at tools we already use. At NYSORA events, industry spotlight sessions focus on practical insights that help clinicians make better-informed decisions in real-world practice.
In this session, Teresa Human, PharmD, PhD, shared a clinician’s perspective on NSAIDs – explaining why not all agents are the same and where IV ibuprofen fits into perioperative pain management today.
From the Neuro ICU to Industry: A Clinician’s Perspective
Teresa Human spent nearly 25 years working in high-acuity Neuro ICUs at the University of Virginia and Washington University / Barnes–Jewish Hospital. After COVID, like many clinicians, she transitioned into industry and is now a Medical Science Liaison at Cumberland Pharmaceuticals, a Nashville-based pharmaceutical company founded in 1999.
What surprised her most in this new role was not the data – but how few clinicians were familiar with it.
Caldolor has been approved since 2009 and is widely used, yet its role in modern, opioid-sparing perioperative care remains underrecognized.
Her goal for this session was simple:
clarify where IV ibuprofen fits, how it differs from other NSAIDs, and why it matters for pain, safety, and cost.
Not All NSAIDs Are the Same
One of the core messages of the talk was that NSAIDs are not interchangeable, and their COX-1 / COX-2 profiles matter.
- COX-1 inhibition is associated with higher risk of bleeding, renal injury, and GI side effects.
- COX-2 selectivity carries increased cardiovascular risk – one reason earlier COX-2–selective drugs were withdrawn from the market.
On this spectrum, ketorolac and ibuprofen sit very differently:
- Ketorolac is roughly 300 times more potent at COX-1 inhibition than ibuprofen.
- This explains why ketorolac is limited to short courses, has strict dosing caps, and was withdrawn from the EU due to safety concerns.
The key takeaway:
Ketorolac and ibuprofen should not be viewed as equivalent alternatives.
What Is Caldolor®?
Caldolor is intravenous ibuprofen, offering the same active drug as oral ibuprofen with a 1:1 IV-to-oral conversion.
It is approved for both pain and fever, with the added advantage of crossing the blood–brain barrier – making it useful in settings where ketorolac is not.
Why it stands out in perioperative care
- Safe preoperative use: Can be given pre-incision as preemptive analgesia
- Supports multimodal strategies: Complements regional anesthesia by addressing inflammatory pain as blocks wear off
- No strict duration limit: Unlike ketorolac, Caldolor does not carry a 5-day maximum when used appropriately
- Seamless transition to PO: Patients can easily switch to oral ibuprofen once tolerated
Speed Matters: Pharmacokinetics in the OR
Originally labeled as a 30-minute infusion, Caldolor has since been studied and widely adopted as a 5–7 minute infusion, a change driven by real-world anesthesiology needs.
- A 5–7 minute IV infusion achieves rapid peak plasma levels
- Faster and more reliable onset compared with oral ibuprofen
- Well suited for administration during induction
A practical approach shared during the session:
- Give one IV dose during induction
- Transition to oral ibuprofen in PACU when possible
- Continue IV dosing only if patients are NPO or have GI limitations
A Practical Addition to Modern Pain Pathways
As healthcare continues to move toward opioid-sparing anesthesia and multimodal pain management, this session highlighted how IV ibuprofen fits naturally into current practice – without changing workflows, techniques, or patient pathways.
It was a reminder that sometimes innovation isn’t about new drugs, but about using familiar medications more intentionally, with better understanding of their differences and strengths.
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Rethinking NSAIDs in Perioperative Pain Management
with Teresa Human, PharmD, PhD
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