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Nishikawa M, Fukuda T, Okazaki M. Predictive factors of postoperative acute pain in laparoscopic inguinal hernia repair in men: A single-centre retrospective study in Japan. J Perioper Pract 2023; 33:133-138. [PMID: 35322720 DOI: 10.1177/17504589211054371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Laparoscopic inguinal hernia repair has significantly reduced the incidence of postoperative acute and chronic pain compared to open repair, but it remains problematic. This study's purpose was to retrospectively identify predictive factors of acute pain after laparoscopic inguinal hernia repair. METHODS We reviewed the medical records of 193 patients. After excluding atypical cases and female patients, 156 patients were analysed. Factors affecting rescue analgesic requirements were investigated via multivariable logistic regression analysis. Independent variables included age, body mass index, analgesics used during surgery and surgical factors (unilateral/bilateral, primary/recurrent). The degree of postoperative pain and the hospital stay duration after surgery were also investigated. RESULTS Of the 156 patients, 40 (25.6%) required rescue analgesics. Patients under 60 years of age were about seven times more likely to need rescue analgesics than patients over 80 years of age. Primary surgery patients were about 5.5 times more likely to need rescue analgesics than recurrent surgery patients. The maximum verbal rating scale score was less than 3 in 89% of patients. All patients were discharged by two days postoperatively. CONCLUSION Laparoscopic inguinal hernia repair results in less postoperative acute pain. However, analgesia management should be considered prudently for younger patients and primary surgery patients.
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Affiliation(s)
- Masashi Nishikawa
- Department of Anesthesiology, Kasumigaura Medical Center Hospital, National Hospital Organization, Tsuchiura, Japan
| | - Taeko Fukuda
- Department of Anesthesiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Tsuchiura Clinical Education and Training Center, Kasumigaura Medical Center Hospital, National Hospital Organization, Tsuchiura, Japan
| | - Masaya Okazaki
- Department of Surgery, Kasumigaura Medical Center Hospital, National Hospital Organization, Tsuchiura, Japan
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Song Y, He Q, Huang W, Yang L, Zhou S, Xiao X, Wang Z, Huang W. New insight into the analgesic recipe: A cohort study based on smart patient-controlled analgesia pumps records. Front Pharmacol 2022; 13:988070. [PMID: 36299897 PMCID: PMC9589502 DOI: 10.3389/fphar.2022.988070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose: Intravenous patient-controlled analgesia (IV-PCA) has been widely used; however, regimen criteria have not yet been established. In China, the most often used opioid is sufentanil, for which repeated doses are a concern, and empirical flurbiprofen axetil (FBP) as an adjuvant. We hypothesized that hydromorphone would be a better choice and also evaluated the effectiveness of FBP as an adjuvant. Methods: This historical cohort study was conducted in two tertiary hospitals in China and included 12,674 patients using hydromorphone or sufentanil for IV-PCA between April 1, 2017, and January 30, 2021. The primary outcome was analgesic insufficiency at static (AIS). The secondary outcomes included analgesic insufficiency with movement (AIM) and common opioid-related adverse effects such as postoperative nausea and vomiting (PONV) and dizziness. Results: Sufentanil, but not the sufentanil-FBP combination, was associated with higher risks of AIS and AIM compared to those for hydromorphone (OR 1.64 [1.23, 2.19], p < 0.001 and OR 1.42 [1.16, 1.73], p < 0.001). Hydromorphone combined with FBP also decreased the risk of both AIS and AIM compared to those for pure hydromorphone (OR 0.74 [0.61, 0.90], p = 0.003 and OR 0.80 [0.71, 0.91], p < 0.001). However, the risk of PONV was higher in patients aged ≤35 years using FBP (hydromorphone-FBP vs. hydromorphone and sufentanil-FBP vs. hydromorphone, OR 1.69 [1.22, 2.33], p = 0.001 and 1.79 [1.12, 2.86], p = 0.015). Conclusion: Hydromorphone was superior to sufentanil for IV-PCA in postoperative analgesia. Adding FBP may improve the analgesic effects of both hydromorphone and sufentanil but was associated with an increased risk of PONV in patients <35 years of age.
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Affiliation(s)
- Yiyan Song
- Department of Anesthesia, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiulan He
- Department of Anesthesia, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenzhong Huang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lu Yang
- Department of Anesthesia, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaopeng Zhou
- Department of Anesthesia, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiaoyu Xiao
- Department of Anesthesia, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zhongxing Wang
- Department of Anesthesia, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Zhongxing Wang, ; Wenqi Huang,
| | - Wenqi Huang
- Department of Anesthesia, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Zhongxing Wang, ; Wenqi Huang,
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Sun M, Cong X, Chang E, Miao M, Zhang J. Efficacy of Flurbiprofen for Postoperative Pain in Chinese Surgical Patients: A Meta-Analysis. J Surg Res 2020; 252:80-88. [PMID: 32247074 DOI: 10.1016/j.jss.2019.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/24/2019] [Accepted: 11/16/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND The objective of this meta-analysis is to assess the analgesic effect of flurbiprofen on postoperative pain in Chinese surgical patients. METHODS The primary outcome was acute postoperative pain scores; the secondary outcomes included total opiate consumption during surgery and adverse effects, such as nausea, vomiting, and dizziness. Results were expressed as weighted mean difference (WMD) or odds ratio with 95% confidence intervals (95% CIs). We evaluated heterogeneity by visually examining the forest plots and quantified it by using the I2 statistic. We used random-effects models to pool the data. RESULTS Of 573 abstracts reviewed, 19 studies involving 1628 participants met the inclusion criteria. Pooled results showed that the intravenous administration of flurbiprofen had a beneficial effect in reducing pain scores at 2 (WMD, -0.78; 95% CI, -1.22 to -0.34; P = 0.001), 6 (WMD, -0.93; 95% CI, -1.40 to -0.46; P = 0.000), 12 (WMD, -1.09; 95% CI, -1.93 to -0.24; P = 0.011), 24 (WMD, -1.08; 95% CI, -1.48 to -0.68; P = 0.000), and 48 (WMD, -0.62; 95% CI, -1.19 to -0.05; P = 0.032) h after surgery. In addition, flurbiprofen administration significantly decreased the incidence of postoperative nausea and vomiting (odds ratio, 0.39; 95% CI, 0.26-0.58; P = 0.000) but had no effects on opiate consumption and dizziness. CONCLUSIONS The perioperative administration of flurbiprofen is effective in reducing postoperative pain, nausea, and vomiting in Chinese surgical patients. Future studies with adequate power should evaluate the ideal flurbiprofen regimen for postoperative pain.
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Affiliation(s)
- Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuhui Cong
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Enqiang Chang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengrong Miao
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
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Wang X, Wang Y, Hu Y, Wang L, Zhao W, Wei L, Chen H, Han F. Effect of flurbiprofen axetil on postoperative delirium for elderly patients. Brain Behav 2019; 9:e01290. [PMID: 31007001 PMCID: PMC6576198 DOI: 10.1002/brb3.1290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Proinflammatory cytokines triggered by surgery and postoperative pain are major causes of postoperative delirium (POD). This study investigated the effects of flurbiprofen axetil on POD when used for postoperative analgesia after major noncardiac surgery in elderly patients. METHODS Patients over 65 years old were randomly divided into two groups: the sufentanil group (S group), in which 150 μg of sufentanil was used in the patient-controlled analgesia (PCA) pump for 3 days; the sufentanil combined with flurbiprofen axetil group (SF group), in which 150 μg of sufentanil was combined with 300 mg of flurbiprofen axetil in the PCA pump for 3 days. The Confusion Assessment Method scale was used for POD evaluation. The pain intensity, side effects, and risk factors (age, gender, surgical position, and category of surgery) for POD were evaluated. RESULTS Ultimately, 140 patients were included. The overall incidence of POD was not significantly different between the S and SF groups. The incidence of POD was significantly lower in the SF group than in the S group among patients over 70 years (5.1% vs. 20.7%, p = 0.045, odds ratio = 0.146, 95% confidence interval = 0.020-1.041). The incidence of POD was no difference in patients classified by the category of surgery, surgical position, or gender between groups. Sufentanil and flurbiprofen axetil in the PCA pump was completely used within 72 hr. The pain intensity, consumed sufentanil dosage of the PCA, and the side effects was not different between groups. CONCLUSIONS Flurbiprofen axetil might reduce POD in patients over 70 years undergoing major noncardiac surgery.
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Affiliation(s)
- Xifan Wang
- Department of Anesthesiology, The Third Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu Wang
- Department of Anesthesiology, The Third Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yanan Hu
- Department of Anesthesiology, The Third Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Liping Wang
- Department of Anesthesiology, The Third Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Wenshuai Zhao
- Department of Anesthesiology, The Third Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Lanying Wei
- Department of Anesthesiology, The Third Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Hong Chen
- Department of Anesthesiology, The Third Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Fei Han
- Department of Anesthesiology, The Third Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
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Preoperative But Not Postoperative Flurbiprofen Axetil Alleviates Remifentanil-induced Hyperalgesia After Laparoscopic Gynecological Surgery: A Prospective, Randomized, Double-blinded, Trial. Clin J Pain 2017; 33:435-442. [PMID: 27518488 DOI: 10.1097/ajp.0000000000000416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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.
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Wang K, Luo J, Zheng L, Luo T. Preoperative flurbiprofen axetil administration for acute postoperative pain: a meta-analysis of randomized controlled trials. J Anesth 2017; 31:852-860. [PMID: 28936554 DOI: 10.1007/s00540-017-2409-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/05/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Non-steroidal anti-inflammatory drugs have been shown to effectively decrease postoperative pain and reduce opioid requirements. Flurbiprofen axetil is an injectable non-selective cyclooxygenase inhibitor that has a high affinity for inflammatory tissues to achieve targeted drug therapy and prolonged duration of action. This meta-analysis examined the use of preoperative flurbiprofen axetil and its impact on postoperative analgesia. METHODS An electronic literature search of the Library of PubMed, Cochrane CENTRAL, and EMBASE databases was conducted in Feb 2016. Searches were limited to randomized controlled trials. The primary outcome was pain scores. The secondary outcomes included cumulative postoperative opioid consumption and opioid-related adverse effects. RESULTS A total of nine RCT studies involving 457 patients were included in this study. Compared to patients without perioperative flurbiprofen axetil, patients treated with preoperative flurbiprofen axetil had lower pain scores at 2 h (SMD -1.00; 95% CI -1.57 to -0.43, P = 0.0006), 6 h (SMD -1.22; 95% CI -2.01 to -0.43; P = 0.002), 12 h (SMD -1.19; 95% CI -2.10 to -0.28; P = 0.01), and 24 h (SMD -0.79; 95% CI -1.31 to -0.27; P = 0.003) following surgery. Preoperative flurbiprofen axetil had no significant effect on postoperative opioid consumption (SMD -13.11; 95% CI -34.56 to 8.33; P = 0.23). There was no significant difference between the groups with regard to adverse effects. Compared to patients with postoperative flurbiprofen axetil, however, preoperative flurbiprofen axetil resulted in decreased pain score only at 2 h after operation. CONCLUSIONS Preoperative use of flurbiprofen axetil will result in significantly lower postoperative pain scores, but no difference in nausea, vomiting, and opioid consumption compared to those who did not receive flurbiprofen axetil. However, more homogeneous and well-designed clinical studies are necessary to determine whether preoperative flurbiprofen axetil administration has more efficacy than that given at the end of surgery.
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Affiliation(s)
- Ke Wang
- Department of Anesthesiology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Jun Luo
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Limin Zheng
- Department of Anesthesiology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, 518036, Guangdong, People's Republic of China.
| | - Tao Luo
- Department of Anesthesiology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, 518036, Guangdong, People's Republic of China.
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A short-term increase of the postoperative naturally circulating dendritic cells subsets in flurbiprofen-treated patients with esophageal carcinoma undergoing thoracic surgery. Oncotarget 2017; 7:18705-12. [PMID: 26959879 PMCID: PMC4951322 DOI: 10.18632/oncotarget.7669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/14/2016] [Indexed: 01/09/2023] Open
Abstract
The present study evaluated whether flurbiprofen increased the naturally circulating dendritic cells (DCs) subsets in patients with esophageal squamous cell carcinoma (ESCC) undergoing esophageal resection. Compared to healthy donors (n=20), the significantly depressed percentages of plasmacytoid DCs (pDCs), CD1c+ myeloid DCs (mDCs), and CD141+ mDCs among ESCC patients (n=60) were confirmed. Flurbiprofen was administered before skin incision and at the end of operation in group F (n=30), as well as placebo in group C (n=30). The postoperative suppressed percentages of pDCs, CD1c+ mDCs, and CD141+ mDCs increased significantly following the perioperative treatment with flurbiprofen. Flurbiprofen also significantly stimulated the postoperative IFN-f and IL-17 production, but inhibited the immunosuppressive IL-10 and TGF-β levels. Furthermore, flurbiprofen exerted a similar analgesic effect and brought a significantly less sufentanil consumption compared to group C. Taken together, flurbiprofen provided a short-term increase of postoperative naturally circulating DCs in ESCC patients.
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Haryalchi K, Abedinzade M, Khanaki K, Mansour Ghanaie M, Mohammad Zadeh F. Whether preventive low dose magnesium sulphate infusion has an influence on postoperative pain perception and the level of serum beta-endorphin throughout the total abdominal hysterectomy. ACTA ACUST UNITED AC 2017; 64:384-390. [PMID: 28214095 DOI: 10.1016/j.redar.2016.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/27/2016] [Accepted: 11/09/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Due to the known role of preventive low dose magnesium sulphate on postoperative pain management, in this randomized, double-blinded, placebo-controlled study, we tried to investigate the possible relationship between low dose intra-operative magnesium sulphate infusion, postoperative analgesia and the level of serum beta-endorphin during total abdominal hysterectomy under general anesthesia. METHODS Forty women undergoing total abdominal hysterectomy were randomly allocated into 2 groups (20 in each arm). Fifteen minutes before induction of anaesthesia, the case group received a continuous intravenous infusion of magnesium sulphate (15mg/kg/h) and placebo control group received the same volume of isotonic saline. Pain scores were assessed at 0, 6, 12, and 24h after operations using Verbal Numeric Rating Scale. Pethidine consumption was recorded precisely. Serum level of beta-endorphin just 15min before the induction and at the end of the operations was determined by ELISA technique. RESULTS At 6 and 12h after the operations, Verbal Numeric Rating Scale in the case group was significantly lower than that of placebo control group (P=.0001). Over 24h after the operations, pethidine consumption was significantly lower in the case group compared with control group (P=.0001). In the case group, serum level of beta-endorphin was significantly decreased at the end of the operations compared with before the induction (P=.04). CONCLUSION We illustrated that preventive low dose intra-operative magnesium sulphate infusion reduces postoperative pain, has opioid sparing effect and declines serum beta-endorphin concentration during total abdominal hysterectomy.
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Affiliation(s)
- K Haryalchi
- Department of Anesthesiology, Reproductive Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - M Abedinzade
- Department of Physiology, Medical Biotechnology Research Center, Faculty of Paramedical Sciences, Guilan University of Medical Science, Rasht, Iran
| | - K Khanaki
- Department of Clinical Biochemistry, Medical Biotechnology Research Center, Faculty of Paramedical Sciences, Guilan University of Medical Sciences, Rasht, Iran.
| | - M Mansour Ghanaie
- Department of Gynaecology, Reproductive Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - F Mohammad Zadeh
- Bachelor of Science, Department of Anesthesiology, Reproductive Health Research Center, Faculty of Paramedical Sciences, Guilan University of Medical Sciences, Rasht, Iran
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Luan YH, Wang D, Yu Q, Chai XQ. Action of β-endorphin and nonsteroidal anti-inflammatory drugs, and the possible effects of nonsteroidal anti-inflammatory drugs on β-endorphin. J Clin Anesth 2017; 37:123-128. [PMID: 28235500 DOI: 10.1016/j.jclinane.2016.12.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 12/02/2016] [Accepted: 12/25/2016] [Indexed: 12/22/2022]
Abstract
This study aimed to review research on the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on β-endorphin. NSAIDs are commonly used as anti-inflammatory and analgesic drugs. They are well known for inducing peripheral analgesia by inhibiting cyclooxygenase (COX). However, an increasing number of studies have shown that NSAIDs have an analgesic effect not only in the periphery but also at the center. It means that a central analgesic mechanism of the action of NSAIDs exists besides the peripheral mechanism, and the central mechanism likely involves β-endorphin. β-Endorphin is one of the most prominent endogenous peptides, existing in the hypophysis cerebri and hypothalamus. It plays an irreplaceable role in the central and peripheral analgesia in the human body mainly through three mechanisms including three parts, the spinal cord, the supraspinal cord, and peripheries. β-Endorphin plays an important role in the development of hyperalgesia. However, the specific signal transduction pathways between prostaglandin E2 or NSAIDs and β-endorphin are still not quite clear. Whether NSAIDs can lead to the increased content of β-endorphin in all patients after any operation needs further investigation. Further studies should determine the optimal dose when NSAIDs and opioid drugs are used together, and also explore the existence of one NSAID that has the potential to replace the traditional opioid drugs and can achieve adequate analgesia.
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Affiliation(s)
- Yuan-Hang Luan
- Department of Anesthesiology, Affiliated Provincial Hospital of Anhui Medical University, Anhui Provincial Hospital, Hefei 230001, China
| | - Di Wang
- Department of Anesthesiology, Affiliated Provincial Hospital of Anhui Medical University, Anhui Provincial Hospital, Hefei 230001, China
| | - Qi Yu
- Department of PET CT, the 105th Hospital of Chinese People's Liberation Army, Hefei 230001, China
| | - Xiao-Qing Chai
- Department of Anesthesiology, Affiliated Provincial Hospital of Anhui Medical University, Anhui Provincial Hospital, Hefei 230001, China.
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Yoshida T, Homma S, Shibasaki S, Shimokuni T, Sakihama H, Takahashi N, Kawamura H, Taketomi A. Postoperative analgesia using fentanyl plus celecoxib versus epidural anesthesia after laparoscopic colon resection. Surg Today 2016; 47:174-181. [PMID: 27194126 DOI: 10.1007/s00595-016-1356-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/19/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE Effective postoperative analgesia is essential to a patient's recovery after laparoscopic colon resection (LCR). We introduce a new analgesic protocol using fentanyl plus celecoxib following LCR. METHODS The subjects of this retrospective comparative study were 137 patients who underwent LCR, 63 of whom were treated with 72 h of epidural anesthesia (group E), and 74 of whom were treated with 24 h of fentanyl intravenous injection followed by 7 days of oral celecoxib (group FC). We evaluated the safety and efficacy of this new protocol. RESULTS The combination of fentanyl and celecoxib maintained a low postoperative pain score (<1.5, evaluated by the FACES Pain Scale) and reduced the need for rescue analgesic drugs for 7 days (groups E vs. FC: 5.39 ± 3.77 vs. 2.79 ± 2.92, p < 0.001). The postoperative hospital stay was almost equal for the two groups (E vs. FC: 11.1 ± 4.5 vs. 10.3 ± 4.8 days, p = 0.315). The operating room stay other than for surgery was significantly shorter for group FC (E vs. FC: 128.7 ± 30.5 vs. 107.2 ± 17.0 min, p < 0.001). Neither group experienced complications, apart from one group FC patient, who suffered transient nausea and vertigo. CONCLUSIONS The new analgesic protocol using fentanyl plus celecoxib is an effective and time-saving strategy for LCR.
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Affiliation(s)
- Tadashi Yoshida
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Shigenori Homma
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Susumu Shibasaki
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tatsushi Shimokuni
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hideyasu Sakihama
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Norihiko Takahashi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hideki Kawamura
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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Wu TT, Wang ZG, Ou WL, Wang J, Yao GQ, Yang B, Rao ZG, Gao JF, Zhang BC. Intravenous flurbiprofen axetil enhances analgesic effect of opioids in patients with refractory cancer pain by increasing plasma β-endorphin. Asian Pac J Cancer Prev 2015; 15:10855-60. [PMID: 25605189 DOI: 10.7314/apjcp.2014.15.24.10855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aimed to investigate the analgesic effect of a combination of intravenous flurbiprofen axetil and opioids, and evaluate the relationship between refractory pain relief and plasma β-endorphin levels in cancer patients. MATERIALS AND METHODS A total of 120 cancer patients was randomly divided into two groups, 60 patients took orally morphine sulfate sustained-release tablets in group A, and another 60 patients receiving the combination treatment of intravenous flurbiprofen axetil and opioid drugs in group B. After 7 days, pain relief, quality of life improvement and side effects were evaluated. Furthermore, plasma β-endorphin levels were measured by radioimmunoassay. RESULTS With the combination treatment of intravenous intravenous flurbiprofen axetil and opioids, the total effective rate of pain relief rose to 91.4%, as compared to 82.1% when morphine sulfate sustained-release tablet was used alone. Compared with that of group A, the analgesic effect increased in group B (p=0.031). Moreover, satisfactory pain relief was associated with a significant increase in plasma β-endorphin levels. After the treatment, plasma β-endorphin level in group B was 62.4±13.5 pg/ml, which was higher than that in group A (45.8±11.2 pg/ml) (p<0.05). CONCLUSIONS Our results suggest the combination of intravenous flurbiprofen axetil and opioids can enhance the analgesic effect of opioid drugs by increasing plasma β-endorphin levels, which would offer a selected and reliable strategy for refractory cancer pain treatment.
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Affiliation(s)
- Ting-Ting Wu
- Department of Oncology, Wuhan General Hospital of Guangzhou Command, People's Liberation Army, Wuhan, China E-mail :
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12
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Flurbiprofen Axetil Enhances Analgesic Effects of Sufentanil and Attenuates Postoperative Emergence Agitation and Systemic Proinflammation in Patients Undergoing Tangential Excision Surgery. Mediators Inflamm 2015; 2015:601083. [PMID: 26273138 PMCID: PMC4530280 DOI: 10.1155/2015/601083] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/16/2015] [Indexed: 12/12/2022] Open
Abstract
Objective. Our present study tested whether flurbiprofen axetil could reduce perioperative sufentanil consumption and provide postoperative analgesia with decrease in emergency agitation and systemic proinflammatory cytokines release. Methods. Ninety patients undergoing tangential excision surgery were randomly assigned to three groups: (1) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by patient-controlled analgesia (PCA) pump, (2) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 100 mg flurbiprofen axetil by PCA pump, and (3) 10 mL placebo and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by PCA pump. Results. Preoperative administration of flurbiprofen axetil decreased postoperative tramadol consumption and the visual analog scale at 4, 6, 12, and 24 h after surgery, which were further decreased by postoperative administration of flurbiprofen axetil. Furthermore, flurbiprofen axetil attenuated emergency agitation score and Ramsay score at 0, 5, and 10 min after extubation and reduced the TNF-α and interleukin- (IL-) 6 levels at 24 and 48 h after the operation. Conclusion. Flurbiprofen axetil enhances analgesic effects of sufentanil and attenuates emergence agitation and systemic proinflammation in patients undergoing tangential excision surgery.
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13
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Ogata K, Takamura N, Tokunaga J, Ikeda T, Setoguchi N, Tanda K, Yamasaki T, Nishio T, Kawai K. A novel injection strategy of flurbiprofen axetil by inhibiting protein binding with 6-methoxy-2-naphthylacetic acid. Eur J Drug Metab Pharmacokinet 2014; 41:179-86. [PMID: 25537338 DOI: 10.1007/s13318-014-0248-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
Abstract
Flurbiprofen axetil (FPA) is an injection product and a prodrug of a non-steroidal anti-inflammatory drug (NSAID). After injection, it is rapidly hydrolyzed to the active form, flurbiprofen (FP). Since frequent injections of FPA can lead to abnormal physiology, an administration strategy is necessary to ensure there is enhancement of the analgesic efficiency of FP after a single dose and to reduce the total number of doses. FP strongly binds to site II of albumin, and thus the free (unbound) FP concentration is low. This study focused on 6-methoxy-2-naphthylacetic acid (6-MNA), the active metabolite of nabumetone (a prodrug of NSAID). We performed ultrafiltration experiments and pharmacokinetics analysis in rats to investigate whether the inhibitory effect of 6-MNA on FP binding to albumin increased the free FP concentration in vitro and in vivo. Results indicated that 6-MNA inhibited the binding of FP to albumin competitively. When 6-MNA was injected in rats, there was a significant increase in the free FP concentration and the area under concentration-time curve (AUC) calculated from the free FP concentration, while there was a significant decrease in the total (bound + free) FP concentration and the AUC calculated from the total FP concentration. These findings indicate that 6-MNA inhibits the protein binding of FP in vivo. This suggests that the frequency of FPA injections can be reduced when administered with nabumetone, as there is increase in the free FP concentration associated with pharmacological effect.
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Affiliation(s)
- Kenji Ogata
- Second Department of Clinical Pharmacy, Graduate School of Clinical Pharmacy, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki, 882-8508, Japan.
| | - Norito Takamura
- Second Department of Clinical Pharmacy, Graduate School of Clinical Pharmacy, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki, 882-8508, Japan
| | - Jin Tokunaga
- Second Department of Clinical Pharmacy, Graduate School of Clinical Pharmacy, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki, 882-8508, Japan
| | - Tetsuya Ikeda
- Division of Neurobiology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
| | - Nao Setoguchi
- Second Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki, 882-8508, Japan
| | - Kazuhiro Tanda
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki, 882-8508, Japan
| | - Tetsuo Yamasaki
- Department of Pharmaceutical Chemistry, Graduate School of Clinical Pharmacy, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki, 882-8508, Japan
| | - Toyotaka Nishio
- Shounan-Hiratuka Pharmacy, Kouei Inc., 6-2 Miyanomae, Hiratuka, Kanagawa, 254-0035, Japan
| | - Keiichi Kawai
- School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kadatsuno, Kanazawa, Ishikawa, 920-0942, Japan
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14
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Zhang L, Zhu J, Xu L, Zhang X, Wang H, Luo Z, Zhao Y, Yu Y, Zhang Y, Shi H, Bao H. Efficacy and safety of flurbiprofen axetil in the prevention of pain on propofol injection: a systematic review and meta-analysis. Med Sci Monit 2014; 20:995-1002. [PMID: 24935068 PMCID: PMC4070992 DOI: 10.12659/msm.890102] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Pain on injection is an acknowledged adverse effect (AE) of propofol administration for the induction of general anesthesia. Flurbiprofen axetil has been reported to reduce the pain of injection. However, results of published papers on the efficacy of flurbiprofen axetil in managing pain on injection of propofol are inconsistent. Material/Methods We conducted a comprehensive meta-analysis of studies to appraise the efficacy and safety of flurbiprofen axetil for controlling pain induced by propofol injection. The pooled risk ratio (RR) with corresponding 95% confidence intervals (CI) was calculated employing fixed- or random-effects models, depending upon the heterogeneity of the included trials. Results Compared with the placebo group, flurbiprofen axetil allows more patients to have no pain (RR 3.51, 95% CI 2.22–5.55, p=0.000), and decreases the cumulative number of patients with mild, moderate, and severe pain on injecting propofol (RR 0.70, 95% CI 0.58–0.86, p=0.000; RR 0.59, 95% CI 0.46–0.75, p=0.000; RR 0.25, 95% CI 0.16–0.38, p=0.000, respectively). In the stratified analysis by the doses, flurbiprofen axetil at a dose of over 50 mg was found to be effective in reducing propofol-induced pain on injection; however, there were no significant differences in relieving pain between treatment and placebo groups with flurbiprofen axetil at a dose of 25 mg. In terms of drug safety, there were no adverse effects (AEs) reported between flurbiprofen axetil-based regimens and placebo regimens. Conclusions Flurbiprofen axetil, an injectable prodrug of flurbiprofen, can significantly prevent or relieve the pain induced by propofol injection. More studies are required to assess its adverse effects.
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Affiliation(s)
- Lieliang Zhang
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Juan Zhu
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Lei Xu
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Xunlei Zhang
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Hongyu Wang
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Zhonghua Luo
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Yamei Zhao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Yi Yu
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Yong Zhang
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Hongwei Shi
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Hongguang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
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15
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Abstract
This paper is the thirty-fourth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2011 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration (Section 16); and immunological responses (Section 17).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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