Abdominal aortic aneurysm (AAA) pain should be considered by the acute care provider as a harbinger of aortic leakage or rupture. Therefore, analgesic selection in AAA is influenced by the high potential for hemodynamic instability. This chapter discusses the role of opioids and NSAIDs in abdominal aortic aneurysm. When treating pain in patients with suspected ruptured AAA, the most important consideration is the effect the analgesic will have on the patient's hemodynamic status. Opioids, in small titrated doses, are the analgesics recommended by experts in AAA pain relief. Most opioids can cause minor reductions in heart rate and blood pressure. Hypotension is much less likely to occur with fentanyl since this agent does not cause histamine release often associated with morphine. In patients with normal renal function, NSAIDs (e.g. ketorolac) have been used perioperatively, without sequelae, in patients undergoing abdominal and retroperitoneal procedures.