Provision of adequate perioperative analgesia is important in enhancing patient mobilization, preventing pulmonary complications, and improving the patient s psychological well-being.9,11 The intraoperative use of high-dose morphine (40 mg) may offer superior postoperative pain relief and enhance patient well-being compared with fentanyl (despite similar times to extubation).46 The safety of nonsteroidal anti-inflammatory agents for analgesia is controversial, with greater evidence for adverse cardiovascular events with the selective cyclooxygenase-2 inhibitors than the nonselective agents. A 2007 AHA Scien- tific statement presented a stepped-care approach to the management of musculoskeletal pain in patients with or at risk for coronary artery disease (CAD), with the goal of limiting the use of these agents to patients in whom safer therapies fail.47 In patients hospitalized with unstable angina (UA) and non ST-elevation myocardial infarction (NSTEMI), these agents should be discontinued promptly and reinstituted later according to the stepped-care approach.48 In the setting of cardiac surgery, nonsteroidal anti- inflammatory agents previously were used for perioperative analgesia. 