Morphine and Dexamethasone Incorporated Cocktail Regimen Efficiently Reduced Postoperative Pain in Patients Undergoing Primary Total Knee Arthroplasty

Purpose: The present study was conducted to evaluate the pain-reducing efficacy and safety of the morphine and dexamethasone incorporated cocktail regimen in patients undergoing total hip arthroplasty (THA).Methods: The current study enrolled 75 patients and randomized them into three groups. The patients in group I were injected with morphine, dexamethasone, bupivacaine, flurbiprofen axetil, and normal saline. Patients assigned to group II were injected with dexamethasone, bupivacaine, flurbiprofen axetil, and normal saline. Patients in group III were given bupivacaine, flurbiprofen axetil, and normal saline. The visual analog scale (VAS) score and active and passive range of movement (ROM) were recorded and evaluated to compare the pain-controlling efficiency. The side effects of headache, dizziness, nausea, vomiting, wound leakage, and wound infection were monitored.Results: The patients in group I had the lowest VAS, and highest active ROM and passive ROM. The VAS reduced from day 1 to day 4, and the ROM increased conversely. The patients in group II presented a smaller reduction in VAS and a smaller increase in ROM, compared to the patients in Group III. The side effects of headache, dizziness, nausea, and vomiting were not recorded. Wound leakage was observed from 4 patients in group I (2 patients) and group II (2 patients). The was no statistical intergroup difference (p = 0.85). No wound infection symptoms were detected.Conclusions: Morphine and dexamethasone incorporated cocktail regimen efficiently reduced postoperative pain in patients undergoing primary total knee arthroplasty.Trial registration: Drug clinical trial registration system, CTR20181569. Registered 20 October 2018, http://www.chinadrugtrials.org.cn/clinicaltrials

Analgesic Outcomes of Tramadol Alone and in Combination with Butorphanol or Flurbiprofen Axetil after Caesarean Section: A Retrospective Study with Propensity Score Matching Analysis

Background: To our knowledge, the Society for Obstetric Anesthesia and Perinatology recommends a multimodal analgesic regimen for caesarean delivery analgesia. Therefore, this study aimed to compare the analgesic effects of tramadol alone and in combination with butorphanol or flurbiprofen axetil after caesarean section.Methods: We retrospectively analysed 2323 women with puerperas who had undergone caesarean section based on the electronic medical records of a teaching hospital in China from January 2018 to January 2020. We collected data on demographic characteristics, perioperative complications, surgical factors, and anaesthesia. We also recorded the postoperative analgesic solution, pain intensity (assessed by the numeric rating scale [NRS]) during the first 48 hours after surgery. Postoperative inadequate analgesia during the postoperative 48 hours was defined as an NRS score ≥4. We also collected data regarding off-bed activity and intestinal function recovery. Analgesic outcomes of three groups were compared using propensity score matching analysis.Results: Compared to the tramadol mixed with butorphanol group (group B), the incidence of inadequate analgesia at rest and while moving was lower in the tramadol combined with flurbiprofen axetil group (group F), and the relative risks (RRs) for women with puerperas suffering from inadequate analgesia at rest and while moving in group F were 0.34 (95% confidence interval [CI]: 0.21–0.54; P<0.001) and 0.24 (95% CI: 0.19–0.31, P<0.001), respectively. The percentage of intestinal function recovery and off-bed activity at 2 days postoperatively was higher in group B than in group F (74.1 versus [vs.] 66.4, P=0.006 and 79.4% vs. 66.4%, P<0.001, respectively). Group F was also associated with a lower incidence of inadequate control of pain at rest and while moving than group T (RR, 0.37 [0.23–0.60], P<0.001, and 0.43 [0.33–0.55], P<0.001, respectively). Group B was associated with a higher incidence of inadequate control of moving pain than group T (RR, 1.78, [1.40–2.26], P<0.001).Conclusions: A combination of tramadol and flurbiprofen axetil could enhance the analgesic effect and be safely used for analgesia after caesarean section, but the combination of tramadol and butorphanol may produce an antagonistic effect.Trial registration: Not applicable.

Ultrasound-Guided Transversus Thoracic Muscle Plane-Pectoral Nerve Block for Postoperative Analgesia After Modified Radical Mastectomy: A Comparison with the Thoracic Paravertebral Nerve Block

Background: Modified radical mastectomy (MRM) is a most effective and common type of invasive surgery for breast cancer. However, it causes moderate to severe acute pain even last for a long postoperative period. Transversus thoracic muscle plane-pectoral nerve block (TTP-PECS) is a novel and promising interfacial plane block which can provide analgesia for MRM while thoracic paravertebral nerve block (TPVB) is also widely used for this purpose. This study compared the postoperative analgesia between the ultrasound-guided TTP-PECS and TPVB in patients undergoing MRM.Methods: In this randomized controlled pilot trial, eighty female breast cancer patients were randomized to receive either ultrasound-guided TTP-PECS (TTP-PECS group, n=40) or TPVB (TPVB group, n=40). The primary outcome was 24 h postoperative fentanyl consumption. Secondary outcome measures included intraoperative fentanyl and postoperative flurbiprofen axetil consumption, duration of analgesia, pain intensity at rest and during activity, inflammatory response, and the quality of recovery 40 (QoR-40) score.Results: Intraoperative fentanyl requirement was similar between the two groups; Postoperative fentanyl consumption was decreased in the TTP-PECS group copmared with the TPVB group, as well as the rate of postoperative flurbiprofen axetil consumption, but the duration of analgesia was longer; Pain scores at rest and during activity were dramatically decreased at postoperative 12 h; Moreover, the levels of IL-6, MCP-1 and TNF-α, as well as the levels of PGE2, NPY and β-endorphins were decreased at 12 h after surgery; Finally, the total QoR-40 score, especially for the scores of pain, emotional state and patient support were increased.Conclusion: Both TTP-PECS and TPVB are effective for analgesia after MRM. However, TTP-PECS reduced postoperative fentanyl and flurbiprofen axetil consumption in the first 24 h after MRM, and prolonged the duration of analgesia. Furthermore, TTP-PECS reduced postoperative pain intensity at rest and during activity, and inflammatory response at 12 h postoperation. Finally, TTP-PECS improved QoR-40 scores on the postoperative day. Thus, TTP-PECS is an attractive alternative to TPVB for postoperative analgesia after MRM.

Efficacy of intravenous flurbiprofen axetil with epidural analgesia for post-cesarean section analgesia: a multi-center, prospective, randomized, blinded trial

BackgroundEpidural analgesia provided satisfactory analgesic effects of incision pain after cesarean section. However, uterine contraction pain is also a common complication that cannot be relieved despite adequate levels of sensory blockade by epidural analgesia. This study evaluates the effect of flurbiprofen axetil with patient-controlled epidural analgesia on incision pain and uterine contraction pain after cesarean section.MethodsA multi-center, prospective, randomized, blinded trial was performed. 1000 obstetric patients scheduled for cesarean delivery were randomized to receive epidural analgesia with intravenous flurbiprofen axetil (group EF) or placebo (group E) postoperatively. The primary outcomes were incision pain and uterine contraction pain score 48 hours after a cesarean section. Secondary outcomes were the PCEA attempts, the incidence of complication, satisfaction scores, and return of gastrointestinal (GI) function.ResultsBaseline characteristics were similar between groups. The VAS of uterine contraction pain was significantly lower in group EF than in group E from 12 hours to 48 hours after cesarean delivery (P < 0.01). The VAS of incision pain at rest and on movement was lower in group EF than in group E from 12 hours to 48 hours after cesarean delivery. While sitting or walking, the VAS of incision pain was lower in group EF compared with that in group E. GI function recovered faster in group EF than that in group E (15 ± 6 vs. 25 ± 12, 95%CI 5.7 to 8.7, P < 0.01). The satisfaction scores are higher in group EF than that in group E (3.2 ± 0.5 vs. 2.9 ± 0.5, 95%CI -0.36 to -0.11, P < 0.01).ConclusionCombination flurbiprofen axetil with PCEA provides more effective analgesia for uterine contraction pain and incision pain after cesarean section, with a higher quality of recovery and better satisfaction scores.Trials RegistrationThis study was approved by the Institutional Review Board of Guangzhou Women and Children’s Medical Center (IRB2017062201) and written informed consent was obtained from his or her parents or legal guardians for each pediatric patient in the trial. The trial was registered before patient enrollment at chictr.org.cn (ChiCTR-IOR-17011956, Principal investigator: Ying-Jun She, Date of registration: 2017.07.12). Written informed consent was obtained from patients in the study.

Efficacy of intravenous flurbiprofen axetil with epidural analgesia for post-cesarean section analgesia: a multi-center, prospective, randomized, blinded trial

BackgroundEpidural analgesia provided satisfactory analgesic effects of incision pain after cesarean section. However, uterine contraction pain is also a common complication that cannot be relieved despite adequate levels of sensory blockade by epidural analgesia. This study evaluates the effect of flurbiprofen axetil with patient-controlled epidural analgesia on incision pain and uterine contraction pain after cesarean section.MethodsA multi-center, prospective, randomized, blinded trial was performed. 1000 obstetric patients scheduled for cesarean delivery were randomized to receive epidural analgesia with intravenous flurbiprofen axetil (group EF) or placebo (group E) postoperatively. The primary outcomes were incision pain and uterine contraction pain score 48 hours after a cesarean section. Secondary outcomes were the PCEA attempts, the incidence of complication, satisfaction scores, and return of gastrointestinal (GI) function.ResultsBaseline characteristics were similar between groups. The VAS of uterine contraction pain was significantly lower in group EF than in group E from 12 hours to 48 hours after cesarean delivery (P < 0.01). The VAS of incision pain at rest and on movement was lower in group EF than in group E from 12 hours to 48 hours after cesarean delivery. While sitting or walking, the VAS of incision pain was lower in group EF compared with that in group E. GI function recovered faster in group EF than that in group E (15 ± 6 vs. 25 ± 12, 95%CI 5.7 to 8.7, P < 0.01). The satisfaction scores are higher in group EF than that in group E (3.2 ± 0.5 vs. 2.9 ± 0.5, 95%CI -0.36 to -0.11, P < 0.01).ConclusionCombination flurbiprofen axetil with PCEA provides more effective analgesia for uterine contraction pain and incision pain after cesarean section, with a higher quality of recovery and better satisfaction scores.Trials RegistrationThis study was approved by the Institutional Review Board of Guangzhou Women and Children’s Medical Center (IRB2017062201) and written informed consent was obtained from his or her parents or legal guardians for each pediatric patient in the trial. The trial was registered before patient enrollment at chictr.org.cn (ChiCTR-IOR-17011956, Principal investigator: Ying-Jun She, Date of registration: 2017.07.12). Written informed consent was obtained from patients in the study.

The Comparison of Plasma and Cerebrospinal Fluid R(−)- and S(+)-Flurbiprofen Concentration After Intravenous Injection of Flurbiprofen Axetil in Human Subjects

Background: Flurbiprofen axetil is a prodrug that releases the active substance through enzymatic removal of the ester moiety. It is formulated through encapsulation in a lipid microsphere carrier, and widely used to treat perioperative pain. Here, we studied the distribution of R (−)- and S (+)-flurbiprofen in human plasma and cerebrospinal fluid (CSF) after intravenous injection of flurbiprofen axetil.Methods: A total of 70 adult patients undergoing elective lower limb surgery under spinal anesthesia were given a single intravenous injection of 100-mg flurbiprofen axetil. The patients were randomly assigned to 10 groups for plasma and CSF sampling at 10 time points (5–50 min) after subarachnoid puncture and before actual spinal anesthesia. R (−)- and S (+)-flurbiprofen and CSF/plasma ratio were determined by liquid chromatography–tandem mass spectrometry.Results: R (−)-flurbiprofen concentration ranged from 2.01 to 10.9 μg/mL in plasma and 1.46–34.4 ng/mL in CSF. S (+)-flurbiprofen concentration ranged from 1.18 to 10.8 μg/mL in plasma and from 2.53 to 47 ng/mL in CSF. In comparison to S (+)-flurbiprofen, R (−)-flurbiprofen concentration was significantly higher in plasma at all time points (p &lt; 0.05) except at 30 or 40 min, and lower in CSF at all time points (p &lt; 0.05) except at 10, 15 and 40 min. Analysis after correcting drug concentration for body mass index also revealed higher plasma and lower CSF R (−)-flurbiprofen concentration. In comparison to S (+)-flurbiprofen, AUC0–50 for R (−)-flurbiprofen was larger in plasma and smaller in CSF (p &lt; 0.05 for both), and accordingly smaller CSF/plasma AUC0–50 ratio (p &lt; 0.05). There was a positive correlation between R (−)-flurbiprofen concentration and S (+)-flurbiprofen concentration in plasma (r = 0.725, p &lt; 0.001) as well as in CSF (r = 0.718, p &lt; 0.001), and a negative correlation between plasma and CSF concentration of S (+)-flurbiprofen (r = −0.250, p = 0.037), but not R (−)-flurbiprofen.Conclusion: Distribution of R (−)- and S (+)-flurbiprofen in plasma and CSF differed significantly. Penetration of R (−)-flurbiprofen into the CNS was lower than S (+)-flurbiprofen.