Effect of Intravenous Acetaminophen and Flurbiprofen on Postoperative Pain after Lumbar Disc Surgery

Aims: Lumbar disc surgery is often associated with moderate to severe postoperative pain. Whether non-steroidal anti-inflammatory drugs or acetaminophen provides effective analgesia following lumbar disc surgery remains controversial. This study aimed to determine whether flurbiprofen produces analgesic effects equivalent to those of acetaminophen after lumbar disc surgery. Study Design: Prospective, randomized, open-label, placebo-controlled trial Place and Duration of Study: Department of Anesthesia, Nagasaki Rosai Hospital, Sasebo, Japan, between April 2018 and March 2019. Methodology: We studied 76 patients who underwent elective lumbar disc surgery under general anesthesia. The patients were randomly allocated to one of three groups. Group A (n=25) received 1000 mg of acetaminophen intravenously every 6 h. Group F (n=25) received 50 mg of flurbiprofen intravenously every 6 h. Group C (n=26) received saline intravenously every 6 h as a placebo. Each drug was started before skin closure 18 h after surgery. All patients were anesthetized under total intravenous anesthesia with propofol and remifentanil and received fentanyl before skin closure. Postoperative pain was evaluated using a numerical rating scale (NRS) at 0, 1, 3, 6, 12, 18, and 24 h postoperatively. The patients were administered diclofenac sodium or loxoprofen, as rescue analgesics, as needed. Results: There were no significant differences in patient characteristics among the three groups. There were no significant differences in NRS scores among the three groups during the study period. However, rescue analgesics were administered significantly less frequently in group F than in groups A and C over 12 h and 24 h, respectively. Conclusion: The results of this study showed that flurbiprofen might provide more effective analgesia than acetaminophen following lumbar disc surgery.

Patient Reported Outcomes (PROs) – a Tool for Strengthening Patient Involvement and Measuring Outcome in Orthopaedic Outpatient Rehabilitation

The present study serves to establish Patient Reported Outcomes (PROs) as a tool for strengthening patient involvement and measuring outcomes in orthopaedic outpatient rehabilitation. Assessments by FFbH-R (Hannover Back Function Questionnaire for patients with back problems), Quick-DASH (Disabilities of Arm, Shoulder, and Hand Score for patients with upper extremity lesions), and LEFS (Lower Extremity Function Scale for patients with lower extremity lesions) were employed in 20 outpatient rehabilitation centres over a period of 12 months to evaluate changes in performance and participation from the subjective patient perspective. The following questionnaires were used: FFbH-R status post: lumbar disc surgery; cervical disc surgery; spinal canal decompression; conservative back pain treatment; other; Quick-DASH status post: rotator cuff reconstruction; shoulder arthroplasty; fracture (conservative or osteosynthesis); other; LEFS status post: hip arthroplasty; knee arthroplasty; anterior cruciate ligament repair; osteotomy; fracture (conservative treatment or osteosynthesis); other. Analysis of the 6,751 usable data sets demonstrated significant positive changes in all scores and diagnostic subgroups. The mean difference in score was 14.2 points in the FFbH-R, − 22 points in the Quick-DASH and 18 points in the LEFS. Thus, this study proves the positive effects of orthopaedic rehabilitation in an outpatient setting. PROs were instituted on a permanent basis in seven of the participating institutions.