Preoperative But Not Postoperative Flurbiprofen Axetil Alleviates Remifentanil-induced Hyperalgesia After Laparoscopic Gynecological Surgery: A Prospective, Randomized, Double-blinded, Trial.

Abstract

BACKGROUND:

Acute remifentanil exposure during intraoperative analgesia might enhance sensitivity to noxious stimuli and nociceptive responses to innocuous irritation. Cyclooxygenase inhibition was demonstrated to attenuate experimental remifentanil-induced hyperalgesia (RIH) in rodents and human volunteers. The study aimed to compare the effects of preoperative and postoperative flurbiprofen axetil (FA) on RIH after surgery.

MATERIALS AND METHODS:

Ninety patients undergoing elective laparoscopic gynecologic surgery were randomly assigned to receive either intravenous placebo before anesthesia induction (Group C); or intravenous FA (1.0 mg/kg) before anesthesia induction (Group F1) or before skin closure (Group F2). Anesthesia consisted off sevoflurane and remifentanil (0.30 μg/kg/min). Postoperative pain was managed by sufentanil titration in the postanesthetic care unit, followed by sufentanil infusion via patient-controlled analgesia. Mechanical pain threshold (primary outcome), pain scores, sufentanil consumption, and side-effects were documented for 24 hours postoperatively.

RESULTS:

Postoperative pain score in Group F1 was lower than Group C. Time of first postoperative sufentanil titration was prolonged in Group F1 than Group C (P=0.021). Cumulative sufentanil consumption in Group F1 was lower than Group C (P<0.001), with a mean difference of 8.75 (95% confidence interval, 5.21-12.29) μg. Mechanical pain threshold on the dominant inner forearm was more elevated in Group F1 than Group C (P=0.005), with a mean difference of 17.7 (95% confidence interval, 5.4-30.0) g. Normalized hyperalgesia area was decreased in Group F1 compared to Group C (P=0.007). No statistically significant difference was observed between Group F2 and Group C.

CONCLUSIONS:

Preoperative FA reduces postoperative RIH in patients undergoing laparoscopic gynecologic surgery under sevoflurane-remifentanil anesthesia.

• Authors: Linlin Zhang, Ruichen Shu, Qi Zhao, Yize Li, Chunyan Wang, Haiyun Wang, Yonghao Yu, Guolin Wang
• Journal: The Clinical journal of pain (Clin J Pain) Vol. 33 Issue 5 Pg. 435-442 (05 2017) ISSN: 1536-5409 [Electronic] United States
• PMID: 27518488 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Analgesics, Opioid
• Anesthetics, Intravenous
• Anti-Inflammatory Agents, Non-Steroidal
• Methyl Ethers
• Piperidines
• Sevoflurane
• Flurbiprofen
• Sufentanil
• flurbiprofen axetil
• Remifentanil

Topics

• Adult
• Analgesics, Opioid (administration & dosage)
• Anesthetics, Intravenous (adverse effects, therapeutic use)
• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage, adverse effects)
• Female
• Flurbiprofen (administration & dosage, adverse effects, analogs & derivatives)
• Forearm (physiopathology)
• Gynecologic Surgical Procedures
• Humans
• Hyperalgesia (chemically induced, drug therapy)
• Laparoscopy
• Methyl Ethers (adverse effects, therapeutic use)
• Middle Aged
• Pain Threshold (drug effects)
• Pain, Postoperative (drug therapy)
• Piperidines (adverse effects, therapeutic use)
• Postoperative Care
• Preoperative Care
• Remifentanil
• Sevoflurane
• Sufentanil (therapeutic use)
• Touch
• Treatment Outcome